Introduction: In a previous study by our group, rabbit antithymocyte globulin (r-ATG) induction was associated with lower rates of rejection when compared to basiliximab in renal transplant recipients (RTR) receiving an early steroid withdrawal (ESW) regimen. In this study, maintenance therapy with tacrolimus was started several days post-transplant in both groups to minimize its nephrotoxic potential early after engraftment. The results of this study led to a clinical intervention whereby tacrolimus was initiated on within post-operative day 1 only when using basiliximab induction. The purpose of this analysis is to assess the efficacy and safety outcomes of r-ATG versus basiliximab in RTR with planned ESW after inception of the tacrolimus clinical intervention.

Methods: A retrospective records review for adult RTR between January 1, 2008, and December 31, 2013 was conducted using the electronic medical health records. Patients were included if they were aged 18 years or older, received induction therapy with either r-ATG or basiliximab, and had maintenance therapy with tacrolimus and mycophenolate with planned ESW. Expanded criteria donors or donation after cardiac death transplants were excluded.

The primary objective was a composite end point of biopsy-proven acute rejection (BPAR), graft loss, and patient death at 1 year posttransplant. Additional endpoints includes individual analyses included other efficacy and safety outcomes.

Results: A total of 169 RTR profiles were reviewed. Of those, 106 patients received r-ATG, 45 patients received basiliximab with early tacrolimus initiation, and 18 were excluded. Within the first year of transplant, no patients died. There was one graft loss during the evaluation period in the r-ATG group and none in basiliximab treated patients. BPAR occurred in 18 patients in the r-ATG group vs 7 patients in the basiliximab group (p=1.000). The time for the first rejection appeared to be later in the r-ATG group (120.4 ± 109.8 days) compared to the basiliximab group (45.3 ± 25.2 days; p=0.099), despite not reaching statistical significance. The estimated glomerular filtration rate (eGFR; ml/min/1.73m²) by MDRD was similar between the groups (r-ATG = 47.8 + 17.1 vs. basiliximab = 53.6 + 19.5; p=0.080).

Conclusion: Frequency and onset of BPAR and graft loss in basliximab patients who immediately start tacrolimus treatment was not statistically different to r-ATG induction therapy in renal transplant recipients who received an ESW regimen.

CITATION INFORMATION: Gabardi S. Induction Treatment with Rabbit Antithymocyte Globulin versus Basiliximab in Renal Transplant Recipients with Planned Early Steroid Withdrawal. Am J Transplant. 2017;17 (suppl 3).

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