Single-dose thymoglobulin induction in living-donor renal transplantation

The use of Thymoglobulin induction therapy in living-donor renal transplantation remains controversial. We aimed to evaluate outcomes in living-related donor (LRD) and living unrelated donor (LURD) renal transplants with Thymoglobulin induction.

We retrospectively analysed the outcome of all Thymoglobulin induced living-donor renal transplants performed at our centre from 2002 to 2010.

We reviewed 100 living-donor renal transplants (LRD=60; LURD=40) who received thymoglobulin induction (single dose, 1.5 mg/kg bodyweight) with a mean follow-up of 52.6 ± 31.9 months. Although baseline characteristics of the LRD and LURD groups were similar, differences were noted for recipient age, gender, and HLA-matching. Overall, the estimated 5-year patient survival was 92% and graft survival, 83%. The 1- and 5-year patient survival rates were 97.4% and 90.7% for LRD and 98.3% and 92.2% for LURD (P=0.79), respectively. Cumulative graft survival (LRD vs. LURD) rates were 93% vs. 95% after 1 year and 80% vs. 88% after 5 years (P=0.53). Kidney graft function was comparable for both the groups. Acute rejection was observed in 17% LRD and 35% LURD patients (P=0.035). Further, 10% of the patients experienced delayed graft function (LRD 11% vs. LURD 8%; P=NS). Rates of cytomegalovirus (CMV) infection (10%), polyomavirus infection (5%), malignancy (4%), and lymphoproliferative disorder (0%) were low, with no differences between the 2 groups.

Single-dose thymoglobulin induction in living-donor renal transplantation was associated with high patient and graft survival without increasing the risk of infections or malignancy and without significant differences between LRD and LURD patients.