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ORIGINAL ARTICLE
Year : 2002  |  Volume : 19  |  Issue : 1  |  Page : 58-62

Prospective randomized trial to evaluate the efficacy of single low dose ATG induction in renal transplant recipient with spousal kidney


Departments of Urology & Kidney Transplantation & Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

Correspondence Address:
Anant Kumar
Department of Urology and Kidney Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow - 226 014
India
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Source of Support: None, Conflict of Interest: None


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Objective: To see the efficacy and safety of single low dose ATG induction on graft survival, rejection, infection and development of malignancy in spousal renal trans­plant recipient. Materials and Methods: A prospective randomized trial was conducted between July 1996-January 2000. Single dose (3.5-5 mg/kg) ATG induction was used in 30 patients while 30 patients were taken as control. Standard triple drug immunosuppression was given to both the groups, while study received additional single shot of rabbit ATG (Fresenius, Germany: 200 mg in 200 ml of saline). The patients were followed up for a mean of 30.4 months (range 19-46 months) in both groups. Graft function, rejections, episodes, anti-rejection therapy, infections and develop­ment of malignancy was analyzed at the last follow-up. Result: There were 24 males and 6 females in control group with a mean age of'44.26 years and 26 males and 4 females in control group with a mean age of 41.26 years. Patients' characteristics in both the groups were compa­rable. A total of 26 (86.3%) patients in induction and 24(80%) patients in control group were evaluated at last follow-up (mean 30.4 vs. 30.2 months). Stable graft func­tion was present in 83.3% patients in induction versus 70% in control group. Impaired graft, function (serum creati­nine >2 mg%) was present only in 10% of control group and none of the patients in the study group at last follow­up. The total number of rejections were 23.3 and 43.3% in induction and control group respectively. 2 patients in each group who developed multiple episodes of rejection progressed to chronic rejection. Steroid resistant rejec­tions were less with induction therapy than with control group (14.4 vs. 30.7%). Apart from increased urinary tract infections in study group (46.7 vs. 23.3%), infection at other sites were comparable in both the groups. 2 patients in study group and 4 patients in control group died with, functioning graft due to medical problems. 2 patients were lost to follow-up in both the groups. I patient required graft nephrectomy in induction group, due to severe graft dysfunction with significant proteinuria. Conclusion: Single shot low dose ATG induction therapy reduces the rejection episodes (p=0.05), but it has not shown any improvement in graft survival at 2'/z years. It is associated with higher urinary infection rates. How­ever, long-term, follow-up is needed to see any benefit of less rejection on long-term graft survival.


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