Factors impacting short and long-term kidney graft survival: Modification by single intra-operative high-dose induction with ATG-Fresenius
Jürgen Kaden, Gottfried May, Andreas Völp, Claus Wesslau
Ann Transplant 2011; 16(4): 81-91
Background: A majority of recipients benefited from the intra-operative single high-dose induction (HDI) with ATG-Fresenius (ATG-F) still leaving a group of recipients who did not profit from this kind of induction. Therefore the aim of this retrospective analysis was 1st to identify the risk factors impacting short and long-term graft survival, and 2nd to assess the efficacy of this type of induction in kidney graft recipients with or without these risk factors.
Material/Methods: A total of 606 recipients receiving two different immunosuppressive treatment regimens (1st: Triple drug therapy [TDT, n=196] consisting mainly of steroids, azathioprine and cyclosporine; 2nd: TDT + 9 mg/kg ATG-F intra-operatively [HDI, n=410]) were included in this analysis and grouped according to their kidney graft survival time (short GST: ≤1yr, n=100 and long GST: >5 yrs, n=506).
Results: The main risk factors associated with a shortened graft survival were pre-transplant sensitization, re-transplantation, rejections (in particular vascular or mixed ones) and the necessity of a long-term anti-rejection therapy. Adding ATG-F single high dose induction to TDT was more efficient in prolonging kidney graft survival than TDT alone not only in recipients without any risk factors (p<0.005) but also in recipients with at least one risk factor (p<0.021). Only in 4.6% of recipients having two or more risk factors this effect could not be demonstrated.
Conclusions: The intra-operative single high-dose induction with ATG-F significantly improves the kidney graft survival in recipients with or without risk factors and can therefore be recommended.
Keywords: ATG induction, anti-lymphocyte globulins, ATG-Fresenius, Kidney Transplantation, patient survival, Graft Survival, Rejection, Risk Factors, panel reactive antibodies