ADVANTAGE OF ANTITHYMOCYTE GLOBULIN INDUCTION IN SENSITIZED KIDNEY RECIPIENTS - A RANDOMIZED PROSPECTIVE-STUDY COMPARING INDUCTION WITH ANDWITHOUT ANTITHYMOCYTE GLOBULIN

Background. Sensitized kidney allograft recipients require special man agement to improve their outcome. One strategy is heavy immunosuppress ion with antilymphocyte antibodies. Controversy continues about the ac tual advantage of induction protocols whilst infections and cancers ar e a constant risk. In addition, little is known about how to handle se nsitized patients with low levels of sensitization. Methods. In this s tudy, we randomized sensitized renal transplant recipients, who receiv ed prophylactic treatment with or without antithymocyte globulin (ATG) , in addition to a standard triple regimen consisting of cyclosporin, steroids and azathioprine at ATG discontinuation. The induction treatm ent consisted of a low-dose ATG course over 10 days. Randomization was stratified on the maximum PRA, according to the live following classe s: 5% < PRA less than or equal to 20%, 20% < PRA less than or equal to 40%, 40% < PRA less than or equal to 60%, 60% < PRA less than or equa l to 80% and 80% < PRA less than or equal to 100%. Results. Eighty nin e patients were enrolled: 47 patients received ATG and 42 did not. ATG induction lowered the incidence of biopsy-proven acute rejection epis odes from 64 to 38%, increased 1 year graft survival from 76 to 89% an d was associated with a higher 1 year inulin clearance (37 +/- 15 vs 4 9 +/- 18 ml/min). ATG-associated side effects were restricted to leuco penia and thrombocytopenia, whereas bacterial and viral infections, ga mmopathies and cancers did not occur more frequently. ATG induction be nefited all sensitized patients, and not only the hypersensitized pati ents. Conclusions. We conclude that ATG induction is beneficial for al l sensitized patients, regardless of their level of sensitization, wit h regard to acute rejection episodes, graft survival and graft functio n. Low-dose ATG is sufficient and prevents additional complications.