Thymoglobulin versus alemtuzumab versus basiliximab kidney transplantation from donors after circulatory death

Asderakis, Argiris ORCID: https://orcid.org/0000-0001-6859-2020, Sabah, Tarique K., Watkins, William J. ORCID: https://orcid.org/0000-0003-3262-6588, Khalid, Usman, Szabo, Laszlo, Stephens, Michael R., Griffin, Sian and Chavez, Rafael 2022. Thymoglobulin versus alemtuzumab versus basiliximab kidney transplantation from donors after circulatory death. Kidney International Reports 7 (4) , pp. 732-740. 10.1016/j.ekir.2022.01.1042

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Abstract

Introduction 3C, a study comparing alemtuzumab versus basiliximab induction immunosuppression in kidney transplants has shown lower acute rejection rate with alemtuzumab but same graft survival. Aim of the current study is to examine the effect of induction immunosuppression (thymoglobulin, alemtuzumab, basiliximab) on the outcome of kidneys after circulatory death (DCD). Methods Data of the 274 DCD patients of the 3C obtained from the sponsor was compounded with the 140 DCD patients who received thymoglobulin in a single centre with the same entry criteria as the 3C, giving 414 patients on three induction regimes. Results There were more male donors (p<0.05) and HLA-DR mismatched patients in the thymoglobulin group (p<0.001). Death-censored graft survival at 6-months was 98.6% in the thymoglobulin, 95.5% in alemtuzumab (p=0.08) and 95.7% in basiliximab group (p=0.09), and at 2-years 97.9% vs. 94.8% (p=0.13, HR 2.8, CI 0.7-10.9), vs. 94.3% (p=0.06, HR 3.5, 95% CI 0.9-13.6) respectively. 2-year overall graft survival was 95% in the thymoglobulin vs. 88% in alemtuzumab (unadjusted p=0.038, adjusted HR 2.4, 95% CI 0.99-5.9) and 91.4% in the basiliximab group (p=0.21). 2-years patient survival was numerically less in the alemtuzumab compared to thymoglobulin group (91.8% vs 97.1%, p=0.052, HR 2.90 95% CI 0.93-9.2). Acute rejection was 17% in the basiliximab, 4.3% in the thymoglobulin and 6% in the alemtuzumab group (p<0.001). Conclusion In DCD transplants, thymoglobulin induction may provide advantage over alemtuzumab in patient survival and the same advantage as alemtuzumab over basiliximab in terms of acute rejection. Differing maintenance immunosuppression may contribute to the difference seen.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Publisher:	Elsevier
ISSN:	2468-0249
Date of First Compliant Deposit:	25 January 2022
Date of Acceptance:	3 January 2022
Last Modified:	25 Apr 2024 01:08
URI:	https://orca.cardiff.ac.uk/id/eprint/146794

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