Purpose: We report the outcomes from our single center experience with the novel induction regimen using rATG (3 mg/kg) in divided doses given on operative day zero and post-operative day one and basiliximab (20 mg) given on day two, followed by steroid-free maintenance therapy for patients with high immunological risk undergoing kidney transplantation.

Methods: We retrospectively reviewed 208 consecutive patients who underwent kidney transplantation from 1/1/2009 to 9/1/2014 at our institution. Patients were identified as high immunological risk if their peak PRA was ≥ 20 or if they underwent previous transplantation. 21 patients were identified in the current rATG plus basiliximab group, and 48 in the historical basiliximab with steroid taper group. Outcomes between the two groups were compared using hospital length of stay, biopsy proven rejection episodes, infectious complications, graft failure, and death, for a period of up to 1 year.

Results: The mean peak PRA in the two groups was 62.6% and 66.6%, respectively. The length of stay patients receiving the current regimen was 4.1 days compared to the historical cohort average of 7.1 days. Readmission rates in the two groups were comparable at 42.8% (9/21) and 54.1% (26/48), respectively. Infectious complications were comparable at a rate of 47.6% (10/21) and 45.8% (22/48) between the two groups. Graft failure occurred in 0% (0/21) and 12.5% (4/48) between the two groups, and death in 0% (0/21) and 2.1% (1/48). Of particular interest, there was a difference in rejection events between the two groups, at 4.8% (1/21) and 12.5% (6/48).

Conclusions: In patients at high immunological risk for rejection, our preliminary data suggests that a regimen of rATG plus basiliximab can be safely used for induction in kidney transplantation.

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