Different induction therapies for kidney transplantation with living donor

The objective of this study was compare no induction with thymoglobulin and basiliximab induction in the incidence of acute rejection in kidney transplantation with living donor.

Methods:

We select all cases of renal transplantation with living donor performed in Hospital das Clínicas de Botucatu da UNESP during the period of January 2010 to December 2013. The group was divided by the type of medication used for induction.

Results:

A total of 90 patients were evaluated. There were no differences in baseline characteristics of age and underlying disease. The rate of biopsy-proven acute rejection was higher in the group without induction (42.9%) compared to basiliximab group (20%) and Thymoglobulin (16.7%), p = 0.04. The rejection by compatibility shows that the identical had the lower rejection rate (10%). The haploidentical group without induction had the highest rejection rates (53.3%). In all distinct group the rejection rates were similar with basiliximab or Thymoglobulin, p = NS. The use of induction therapy was associated independently with a lower risk of rejection (OR = 0.32 CI: 0.11 to 0.93, p = 0.036). There were no differences in renal function at 6 months and patient survival and graft in the three groups.

Discussion:

The haploidentical patients without induction were those with higher rates of acute rejection. The group of patients induced with Thymoglobulin had a higher immunological risk, however showed low rates of rejection.

Conclusion:

The use of induction therapy resulted in lower rates of rejection in transplantation with living donor.

Keywords:
graft rejection; immunosuppression; living donors

		Induction Therapy			p
		None N = 42 (A)	Basiliximab N = 30 (B)	Thymoglobulin N = 18 (C)	p
Males		61.9%	76.7%	38.9%	0.033^* * Chi-square;
Age (years)		36.50 ± 10.4	35.30 ± 18.9	34.83 ± 11.3	NS
	Hypertension	4.8%	16.7%	11.1%
	DM	9.5%	10.0%	5.6%	NS
Baseline disease	CGN	31.0%	20.0%	44.4%
	Undetermined	35.7%	20.0%	27.8%
	Other	19.0%	33.3%	11.1%
Time on follow-up (months)		23.83 ± 14.3	28.67 ± 12.0	10.56 ± 7 (A/B)	0.0001⁺ + ANOVA;
Panel reactive antibodies (%)		2.97 ± 6.4	5.74 ± 18.1	23.64 ± 34.9	0.06^# # Kruskal-Wallis.
On tacrolimus		71.4%	100.0%	100.0%	0.0001^* * Chi-square;
On mycophenolate		97.6%	93.3%	100.0%	NS
On prednisone		100.0%	100.0%	100.0%	NS
On sirolimus		0%	0%	0%	NS
On azathioprine		2.4%	6.7%	0%	NS
On cyclosporine		2.4%	0%	0%	NS
PO de Alta (dias)		13.57 ± 18.4	11.33 ± 6.5	11.28 ± 5	NS
Creatinine at discharge (mg/dl)		1.59 ± 0.7	1.28 ± 0.5	1.22 ± 0.4	NS
Creatinine at six months (mg/dl)		1.36 ± 0.5	1.34 ± 0.7	1.33 ± 0.5	NS
HLA	Identical	24.4%	0%	11.1%
	Haploidentical	73.2%	30.0%	27.8%	0.0001^* * Chi-square;
	Non-identical	2.4%	70.0%	61.1%
Acute Rejection		42.9%	20.0%	16.7%	0.044^* * Chi-square;
Categorization	Banff I A+B	38.9%	80%	33.3%
	Banff II A	44.4%	20%	0	0.059^* * Chi-square;
	Banff III	0	0	33.3%
	Antibody-mediated	5.6%	0	33.3%
	Mixed	11.1%	0	0
C4d		29.4%	0	66.7%	NS
Death		4.8%	0%	0%	NS
Graft Loss		2.4%	3.3%	0%	NS

Rejection cases per type of HLA compatibility		Induction Therapy		p
Rejection cases per type of HLA compatibility	None (A)	Basiliximab (B)	Thymoglobulin (C)	p
Identical	10%	0%	0%	NS
Haploidentical	53.3%	11.1%	0%	0.013^* * Chi-square.
Non-identical	0%	23.8%	27.3%	NS

Sociedade Brasileira de Nefrologia Rua Machado Bittencourt, 205 - 5ºandar - conj. 53 - Vila Clementino - CEP:04044-000 - São Paulo SP, Telefones: (11) 5579-1242/5579-6937, Fax (11) 5573-6000 - São Paulo - SP - Brazil
E-mail: bjnephrology@gmail.com

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[1] Correspondence to: Luis Gustavo Modelli de Andrade. Serviço de Transplante Renal do Hospital das Clínicas de Botucatu - UNESP. Faculdade de Medicina de Botucatu - UNESP Departamento de Clínica Médica - Nefrologia. Av. Prof. Montengro s/nº. Distrito de Rubião Junior. Botucatu, SP, Brasil. CEP: 18618-970. E-mail: landrade@fmb.unesp.br