Rabbit antithymocyte globulin: a postoperative risk factor for sirolimus-treated renal transplant patients?

Area of Science:

• Nephrology
• Transplantation Surgery
• Immunosuppression

Background:

• Sirolimus is used in renal transplantation, but studies suggest it may increase perioperative wound complications.
• Rabbit antithymocyte globulin (rATG) is an immunosuppressive agent used in certain transplant scenarios.

Purpose of the Study:

• To analyze the effect of rabbit antithymocyte globulin (rATG) on postoperative wound complications in sirolimus-treated renal transplant patients.
• To compare wound complication rates between patients receiving basiliximab versus rATG induction.

Main Methods:

• A retrospective analysis of 412 renal transplants performed between 2001 and 2003.
• Patients received corticosteroids and sirolimus, with delayed cyclosporine introduction.
• Group 1 received basiliximab (n=283), while Group 2 received rATG (n=129) for induction, particularly for high PRA or retransplant patients.
• Patients with rejection or <30 days follow-up were excluded, leaving 350 patients for analysis (235 basiliximab, 115 rATG).
• Postoperative complications including hernias, wound infections, and lymphoceles were analyzed using the chi-square test.

Main Results:

• Overall wound complications were higher in the rATG group (39.1%) compared to the basiliximab group (26.0%) (P < .025).
• Incisional hernias were significantly more frequent in the rATG group (18.3%) versus basiliximab (10.6%) (P < .05).
• No significant differences were observed in wound infection or lymphocele rates between the groups.

Conclusions:

• Rabbit antithymocyte globulin (rATG) induction in renal transplant recipients on sirolimus, cyclosporine, and steroids is linked to a higher incidence of incisional hernias.
• A trend towards increased lymphocele and wound infection complications was noted with rATG induction.
• These findings suggest careful consideration of immunosuppressive induction agents in sirolimus-treated kidney transplant patients to mitigate wound complication risks.