Clinical outcome of induction therapies in patients undergoing renal transplantation

The goal of Induction therapy is to prevent acute rejection during the
early posttransplantation period by providing a high degree of Immunosuppression at
the time of transplantation. Induction therapy is often considered essential to optimize
outcomes, especially in patients at high risk for poor short-term outcomes. The optimal
prophylactic induction immunosuppressive therapy to prevent kidney transplant rejection
remains controversial and historically, immunosuppressant selection was solely
based on efficacy in preventing rejection.
Methods: In a cross-sectional retrospective study, 410 cases of renal graft recipients
were reviewed in the Hasheminejad Hospital, Tehran, Iran from March 2008 to March
2011. The adult patients with induction therapy with age over 18 years were studied for
the indication, results and adverse effects of Induction therapy.
Results: From 66 transplanted patients with induction therapy, 44(66.7%) patients were
male. The mean age±SD of patients with induction therapy was 39.9±13.2 years. The
most common cause of Induction therapy was cadaveric transplantation (45.5%), other
causes was the prior history of transplantation (24.2%), without risk factor of rejection,
panel reactivity test (PRT)>20% and delay graft function. Anti-thymocyte globulin
(rabbit) is the most commonly used agent (97%) for induction therapy. The rate of
acute rejection was 16.7% percent (11 patients), that the most of them related to the
panel positive patients. The most common adverse effect of anti-thymocyte globulin
was thrombocytopenia (15.2%) and the rate of New Onset Diabetes mellitus After
transplantation (NODAT) and leukopenia was 10.6%, 1.5%, respectively. The urine
culture was positive in 6 (9.1%) patients with induction therapy and positive blood culture
was seen in one patient (1.5%). The viral and fungal infections were not seen.
Conclusion: No standard Induction immunosuppressive regimen exists for patients undergoing
renal transplantation. Anti-thymocyte globulin with low dose regimen is the
most commonly used agent. The PRT>20% had the most association with acute allograft
rejection. The most common side effect of induction therapy was thrombocytopenia