This study evaluated the impact of induction therapy with thymoglobulin (ATG) on outcome in hepatitis C virus positive (HCV+) kidney transplant recipients.

We retrospectively studied 79 HCV+ kidney transplant recipients from Jan 1995 to Dec 2006 at our center. Thirty-nine patients received ATG and 40 received no induction. All patients received calcineurin inhibitor, mycophenolate and steroid maintenance. We compared the rate of infection, as well as graft and patient survival between two groups.

There was no difference in the rate of infection in ATG group compared with no induction group (41% vs. 40%, p=0.93). Graft and patient survival rates were significantly better in ATG group. Patient survival was 94.9%, 82.1%, and 79.5% at 1, 3 and 5 years in the ATG group, and 85%, 69.7% and 61.7% at 1, 3 and 5 years in the no induction group, respectively (p=0.005). Graft survival was 94.7%, 80.4% and 77.4% at 1, 3 and 5 years in the ATG group, and 92%, 83.3%, and 58.1% at 1, 3 and 5 years in the no induction group, respectively (p=0.005).

The ATG group consisted of significantly more highly sensitized recipients with panel reactive antibody >80% (p=0.001) and more of the recipients in this group received organs from HCV infected donors (p=0.03). In spite of this, in this small center cohort, the use of ATG had a significant positive impact on both patient and graft survival in HCV+ recipients without increase in the rate of infectious complications.

In conclusion, HCV+ recipients could achieve safe and excellent short- and long- term outcomes with ATG induction therapy.

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