Thymoglobulin versus ATGAM induction therapy in pediatric kidney transplant recipients: A single-center report

Background. Induction immunosuppressive therapy with the anti-T-cell antibody Thymoglobulin decreases the incidence of acute rejection in adult kidney transplant (KTx) recipients, but limited data are available for pediatric KTx recipients. Methods. We conducted a historical cohort study to compare rates of survival, rejection, and infection in pediatric (age < 19 years) KTx recipients who received induction therapy with polyclonal antibody, ATGAM (n= 127) or Thymoglobulin (n= 7 1), from December 1, 1992, to January 31, 2003. Maintenance immunosuppression included cyclosporine, azathioprine or mycophenolate mofetil, and prednisone. Mean follow-up was 90 +/- 25 months for ATGAM recipients and 32 +/- 15 months for Thymoglobulin recipients. Results. Overall, the incidence of acute rejection was lower in Thymoglobulin recipients versus ATGAM recipients (33% vs. 50%, P=0.02). Epstein-Barr virus (EBV) infection was higher in Thymoglobulin recipients versus ATGAM recipients (8% vs. 3%, P=0.002). But the two groups did not significantly differ in patient and graft survival rates, incidence of chronic rejection, EBV lymphoma, or other infection. Conclusions. Thus, Thymoglobulin induction was associated with a decreased incidence of acute rejection and an increased incidence of EBV infection in pediatric KTx recipients. EBV monitoring should be performed in EBV-naive recipients receiving Thymoglobulin.