Background: In organ grafts donor-specific sensitization is initiated immediately after revascularization. Therefore, in 1990 we introduced the intra-operative single high-dose ATG-Fresenius (ATG-F) induction in addition to standard triple drug therapy (TDT) consisting of steroids, azathioprine and cyclosporin. A total of 778 first renal transplantations from deceased donors, performed between 1987 and 1998, were included in this evaluation.
Material/Methods: This retrospective analysis of clinic records and electronic databases presents data of all recipients of first kidney grafts who received two different ATG-F inductions (1[sup]st[/sup] group: 9 mg/kg body weight as single high-dose intra-operatively, n=484; 2[sup]nd[/sup] group: 3 mg/kg body weight on 7 or 8 consecutive days as multiple-dose starting also intra-operatively, n=78) and standard TDT alone (3[sup]rd[/sup] group: TDT alone, n=216).
Results: The 10-year patient survival rates were 72.6±2.6% (TDT + ATG-F single high-dose), 79.5±5.1% (TDT + ATG-F multiple-dose) and 67.2±3.7%% (TDT alone; Kaplan-Meier estimates with standard errors; ATG-F vs TDT alone, p=0.001). The 10-year graft survival rates with censoring of patients that died with a functioning graft were 73.8±2.4%, 57.7±5.8% and 58.4±3.6% (Kaplan-Meier estimates with standard errors; 1[sup]st[/sup] vs 2[sup]nd [/sup]and 3[sup]rd[/sup] group, respectively, p<0.001) and the 10-year graft survival rates with patient death counted as graft failure were 58.3±2.7%, 55.7±5.8% and 48.2±3.5% (Kaplan-Meier estimates with standard errors; ATG-F single high-dose vs TDT, p=0.023). In pre-sensitized recipients there were also significant differences in favour of ATG-F, more notably in the single high-dose ATG-F induction. A total of 69% of the patients in the two cohorts receiving ATG-F did not experience any transplant rejections compared to 56% in patients undergoing TDT alone (p=0.018). The incidence of infectious complications was comparable across all groups.
Conclusions: According to evidence obtained from the routine documentation of 778 renal transplantations, ATG-F induction therapy administered as a part of immunosuppressive therapy significantly improves patient survival and reduces the risk of graft failure and transplant rejections.

Keywords: Graft Survival, ATG induction, Kidney Transplantation, patient survival, Rejection