Rabbit Anti-Thymocyte Globulin Versus Basiliximab in Spousal Kidney Transplant: Early Immunological and Clinical...

Spousal living donor kidney transplant is commonly performed; however, the optimal induction immunosuppression strategy in recipients with low immunological risk remains unclear. We compared the early clinical and immunological outcomes of low -dose rabbit anti -thymocyte globulin and basiliximab in low -risk spousal kidney transplant recipients.

We retrospectively analyzed 43 recipients with low immunological risk who underwent spousal living donor kidney transplant and received induction therapy with either rabbit anti -thymocyte globulin (n = 20 ) or basiliximab (n = 23 ). Low immunological risk was defined as first -time transplant with negative panel reactive antibody and negative complement -dependent cytotoxicity crossmatch. Primary endpoints were early graft function, as assessed by serum creatinine trends, and biopsy -proven acute rejection within the first 2 postoperative months. Secondary endpoints included perioperative lymphocyte dynamics and documented infections, including cytomegalovirus and urinary tract infections.

Peripheral blood lymphocyte counts were significantly lower in the group treated with rabbit anti -thymocyte globulin on postoperative day 1 and day 7 versus the basiliximab -treated group (P < .001 ). In contrast, no significant differences were observed between groups in early graft function trajectories (P = .71 ) or the incidence of biopsy-proven acute rejection (rabbit anti -thymocyte globulin, 3 of 20; vs basiliximab, 2 of 23; P > .05 ). All documented urinary tract infections (n =3 ) and the single cytomegalovirus infection occurred in the group treated with rabbit anti -thymocyte globulin; however, these differences were not statistically significant (P > .05 ).

In spousal kidney transplant recipients with low immunological risk, low -dose rabbit anti -thymocyte globulin (4.5 mg /kg ) and basiliximab provide comparable early graft function and similar protection against acute rejection. Although rabbit anti -thymocyte globulin induces more pronounced lymphocyte depletion, this observation does not translate into superior early clinical outcomes in this patient population.