Evaluating safety and efficacy of rabbit antithymocyte globulin induction in elderly kidney transplant recipients

Kamran Khanmoradi, John P. Knorr, Eyob L. Feyssa, Afshin Parsikia, Pankaj Jawa, Duy Bao Dinh, Stalin Campos, Radi F. Zaki, Jorge A. Ortiz

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The optimal immunosuppression regimen for elderly kidney transplant recipients is poorly defined. We sought to evaluate the shortterm efficacy and safety of thymoglobulin in geriatric recipients of deceased-donor kidneys. Materials and Methods: A single-center, retrospective analysis was undertaken between elderly (≥ 65 years) (n=137) and nonelderly (n=276) kidney transplant recipients who received rabbit antithymocyte globulin induction and calcineurin inhibitor, mycophenolic acid, and prednisone maintenance. Results: The mean age was 70 versus 52 years. Fewer elderly patients had an earlier transplant or panel reactive antibodies > 20%, but had more machine perfused, older, and extended criteria donor kidneys. Elderly patients received lower rabbit antithymocyte globulin (5.4 vs 5.6 mg/kg; P =.04) and initial mycophenolic acid doses (1620 vs 1774 mg; P =.002), and experienced less delayed graft function (31.1% vs 50.0%; P <.001). Death-censored graft survival and graft function at 3 years and biopsy-proven acute rejection at 1 year were comparable; however, there was lower 3-year patient survival in elderly patients. Donor age was the only factor associated with reduced patient survival. Rates of malignancy, infection, or thrombocytopenia were similar; however, leukopenia occurred less frequently in elderly patients (11.7% vs 19.9%; P =.038). Conclusions: Elderly kidney transplant recipients receiving rabbit antithymocyte globulin did not experience different short-term graft survival, graft function or rates of infection, malignancy or hematologic adverse reactions than did nonelderly patients; they experienced fewer episodes of delayed graft function, but had lower 3-year patient survival.

Original languageEnglish (US)
Pages (from-to)222-228
Number of pages7
JournalExperimental and Clinical Transplantation
Volume11
Issue number3
DOIs
StatePublished - Jun 2013

All Science Journal Classification (ASJC) codes

  • Transplantation

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