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A prospective, randomized, clinical trial of intraoperative versus postoperative Thymoglobulin in adult cadaveric renal transplant recipients.
Transplantation. 2003 Sep 15; 76(5):798-802.T

Abstract

BACKGROUND

Delayed graft function (DGF) is frequently observed in recipients of cadaveric renal transplants. Previous retrospective or nonrandomized studies have suggested that intraoperative administration of polyclonal antithymocyte preparations may reduce the incidence of DGF, possibly by decreasing ischemia-reperfusion injury.

METHODS

We performed a prospective randomized study of Thymoglobulin induction therapy in adult cadaveric renal transplant recipients. Between January 2001 and January 2002, 58 adult cadaveric renal transplant recipients were randomized to receive intraoperative or postoperative Thymoglobulin induction therapy. Three to six doses of Thymoglobulin (1 mg/kg/dose) were administered during the first week posttransplant. Baseline immunosuppression consisted of tacrolimus (54 of 58) or cyclosporine A (4 of 58), steroids, and mycophenolate mofetil. DGF was defined by the requirement for hemodialysis within the first week posttransplant.

RESULTS

There were no significant differences between the two groups in recipient demographics, donor age, cold ischemia time, or total number of doses of Thymoglobulin administered. Intraoperative Thymoglobulin administration was associated with significantly less DGF and a lower mean serum creatinine on postoperative days 10 and 14 (P<0.05). Posttransplant length of stay was also significantly shorter for the intraoperative Thymoglobulin patient group. The acute rejection rate was also lower in the intraoperative treatment group but this did not achieve statistical significance. There was no difference in the incidence of cytomegalovirus disease between the two groups.

CONCLUSIONS

The results of this study indicate that intraoperative Thymoglobulin administration, in adult cadaveric renal transplant recipients, is associated with a significant decrease in DGF, better early allograft function in the first month posttransplant, and a decreased posttransplant hospital length of stay.

Authors+Show Affiliations

Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. wgoggins@iupui.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

14501856

Citation

Goggins, William C., et al. "A Prospective, Randomized, Clinical Trial of Intraoperative Versus Postoperative Thymoglobulin in Adult Cadaveric Renal Transplant Recipients." Transplantation, vol. 76, no. 5, 2003, pp. 798-802.
Goggins WC, Pascual MA, Powelson JA, et al. A prospective, randomized, clinical trial of intraoperative versus postoperative Thymoglobulin in adult cadaveric renal transplant recipients. Transplantation. 2003;76(5):798-802.
Goggins, W. C., Pascual, M. A., Powelson, J. A., Magee, C., Tolkoff-Rubin, N., Farrell, M. L., Ko, D. S., Williams, W. W., Chandraker, A., Delmonico, F. L., Auchincloss, H., & Cosimi, A. B. (2003). A prospective, randomized, clinical trial of intraoperative versus postoperative Thymoglobulin in adult cadaveric renal transplant recipients. Transplantation, 76(5), 798-802.
Goggins WC, et al. A Prospective, Randomized, Clinical Trial of Intraoperative Versus Postoperative Thymoglobulin in Adult Cadaveric Renal Transplant Recipients. Transplantation. 2003 Sep 15;76(5):798-802. PubMed PMID: 14501856.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A prospective, randomized, clinical trial of intraoperative versus postoperative Thymoglobulin in adult cadaveric renal transplant recipients. AU - Goggins,William C, AU - Pascual,Manuel A, AU - Powelson,John A, AU - Magee,Colm, AU - Tolkoff-Rubin,Nina, AU - Farrell,Mary Lin, AU - Ko,Dicken S C, AU - Williams,Winfred W, AU - Chandraker,Anil, AU - Delmonico,Francis L, AU - Auchincloss,Hugh, AU - Cosimi,A Benedict, PY - 2003/9/23/pubmed PY - 2003/10/18/medline PY - 2003/9/23/entrez SP - 798 EP - 802 JF - Transplantation JO - Transplantation VL - 76 IS - 5 N2 - BACKGROUND: Delayed graft function (DGF) is frequently observed in recipients of cadaveric renal transplants. Previous retrospective or nonrandomized studies have suggested that intraoperative administration of polyclonal antithymocyte preparations may reduce the incidence of DGF, possibly by decreasing ischemia-reperfusion injury. METHODS: We performed a prospective randomized study of Thymoglobulin induction therapy in adult cadaveric renal transplant recipients. Between January 2001 and January 2002, 58 adult cadaveric renal transplant recipients were randomized to receive intraoperative or postoperative Thymoglobulin induction therapy. Three to six doses of Thymoglobulin (1 mg/kg/dose) were administered during the first week posttransplant. Baseline immunosuppression consisted of tacrolimus (54 of 58) or cyclosporine A (4 of 58), steroids, and mycophenolate mofetil. DGF was defined by the requirement for hemodialysis within the first week posttransplant. RESULTS: There were no significant differences between the two groups in recipient demographics, donor age, cold ischemia time, or total number of doses of Thymoglobulin administered. Intraoperative Thymoglobulin administration was associated with significantly less DGF and a lower mean serum creatinine on postoperative days 10 and 14 (P<0.05). Posttransplant length of stay was also significantly shorter for the intraoperative Thymoglobulin patient group. The acute rejection rate was also lower in the intraoperative treatment group but this did not achieve statistical significance. There was no difference in the incidence of cytomegalovirus disease between the two groups. CONCLUSIONS: The results of this study indicate that intraoperative Thymoglobulin administration, in adult cadaveric renal transplant recipients, is associated with a significant decrease in DGF, better early allograft function in the first month posttransplant, and a decreased posttransplant hospital length of stay. SN - 0041-1337 UR - https://www.unboundmedicine.com/medline/citation/14501856/A_prospective_randomized_clinical_trial_of_intraoperative_versus_postoperative_Thymoglobulin_in_adult_cadaveric_renal_transplant_recipients_ DB - PRIME DP - Unbound Medicine ER -