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Induction Immunosuppression in Kidney Transplant Recipients Older than 60 Years of Age

Safety and Efficacy of ATGAM®, OKT3® and Simulect®

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Abstract

Background

The choice of induction immunosuppression for kidney transplantation in elderly recipients is dictated by the consideration of the risk of infection as well as efficacy in the prevention of acute rejection, thus allowing a reduction in subsequent maintenance immunosuppression and its attendant long-term adverse effects.

Objective

To compare the efficacy and safety of the antibody induction immunosuppression strategies in elderly recipients of kidney transplants.

Patients and methods

We present retrospective data analysis on 183 kidney transplant recipients ≥60 years of age at Hahnemann University Hospital (Philadelphia, PA, USA) over a 12-year period. We compared four consecutive cohorts of kidney transplant recipients receiving lymphocyte immune globulin, equine antithymocyte globulin (ATGAM®) [n = 29]; muromonab CD3 (OKT3®) [n = 45]; basiliximab (Simulect®) with corticosteroid maintenance [n = 40]; and Simulect® without corticosteroid maintenance (n = 69).

Results

Delayed graft function (DGF) was observed in 48% of patients receiving ATGAM®, 35.6% in the OKT3® group and 35% in the Simulect® group with corticosteroid maintenance and 36.2% in the Simulect® group without corticosteroid maintenance.

The rejection rate within the first 3 months was 31% in the ATGAM® and OKT3® groups, 17.5% in the Simulect® group with corticosteroid maintenance and 14.5% in the Simulect® group without corticosteroid maintenance.

These differences for DGF and acute rejection were statistically significant between patients receiving ATGAM® and OKT3®, ATGAM® or OKT3® and both groups of Simulect® (all p < 0.05). Patients receiving Simulect® were free of adverse effects typically encountered by patients receiving polyclonal and monoclonal antibodies for induction. Patients receiving Simulect® had much shorter hospital stays and benefited from significant reduction of costs compared with other groups.

Conclusion

Our data indicate that kidney transplant recipients ≥60 years of age benefit from induction therapy with Simulect® followed by corticosteroid-free maintenance immunosuppression.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

This work was funded internally by clinical revenue of the Transplant Program. There are no conflicts of interest directly relevant to the content of this study.

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Authors and Affiliations

  1. Hahnemann University Hospital/Drexel University College of Medicine, Philadelphia, Pennsylvania, USA

    Michael Heifets, Muhammad I. Saeed, Mitten H. Parikh, Debra Sierka &  Mysore S. A. Kumar

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  1. Michael Heifets
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  2. Muhammad I. Saeed
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  3. Mitten H. Parikh
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  4. Debra Sierka
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  5. Mysore S. A. Kumar
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Correspondence to Mysore S. A. Kumar.

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Heifets, M., Saeed, M.I., Parikh, M.H. et al. Induction Immunosuppression in Kidney Transplant Recipients Older than 60 Years of Age. Drugs Aging 21, 747–756 (2004). https://doi.org/10.2165/00002512-200421110-00005

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