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Title
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Daclizumab versus antithymocyte globulin in high-immunological-risk renal transplant recipients
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Author
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Abstract
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| Nondepleting anti-CD25 monoclonal antibodies (daclizumab) and depleting polyclonal antithymocyte globulin (Thymoglobulin) both prevent acute rejection, but these therapies have not been directly compared in a high-risk, HILA-sensitized renal transplant population. We randomly assigned 227 patients, who were about to receive a kidney graft from a deceased donor, to either Thymoglobulin or daclizumab if they met one of the following risk factors: current panel reactive antibodies (PRA) >30%; peak PRA >50%; loss of a first kidney graft from rejection within 2 yr of transplantation; or two or three previous grafts. Maintenance immunosuppression comprised tacrolimus, mycophenolate mofetil, and steroids. Compared with the daclizumab group, patients treated with Thymoglobulin had a lower incidence of both biopsy-proven acute rejection (15.0% versus 27.2%; P = 0.016) and steroid-resistant rejection (2.7% versus 14.9%; P = 0.002) at one year. One-year graft and patient survival rates were similar between the two groups. In a comparison of rejectors and nonrejectors, overall graft survival was significantly higher in the rejection-free group (87.2% versus 75.0%; P = 0.037). In conclusion, among high-immunological-risk renal transplant recipients, Thymoglobulin is superior to daclizumab for the prevention of biopsyproven acute rejection, but there is no significant benefit to one-year graft or patient survival. |
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Language
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English
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Source (journal)
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Journal of the American Society of Nephrology. - Baltimore, Md, 1990, currens
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Publication
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Baltimore, Md
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2009
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ISSN
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1046-6673
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DOI
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10.1681/ASN.2008101037
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Volume/pages
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20
:6
(2009)
, p. 1385-1392
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ISI
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000266617200031
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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