Induction immunosuppression in kidney transplant recipients older than 60 years of age: Safety and efficacy of ATGAM®, OKT3® and simulect®

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

Research output: Contribution to journalArticle

15 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)747-756
Number of pages10
JournalDrugs and Aging
Volume21
Issue number11
DOIs
StatePublished - Oct 6 2004

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Muromonab-CD3
Antilymphocyte Serum
Immunosuppression
Kidney
Safety
Maintenance
Adrenal Cortex Hormones
Delayed Graft Function
Transplant Recipients
basiliximab
Kidney Transplantation
Horses
Immunoglobulins
Length of Stay
Monoclonal Antibodies

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Pharmacology (medical)

Cite this

Induction immunosuppression in kidney transplant recipients older than 60 years of age : Safety and efficacy of ATGAM®, OKT3® and simulect®. / Heifets, Michael; Saeed, Muhammad I.; Parikh, Mitten H.; Sierka, Debra; Kumar, Mysore S.A.

In: Drugs and Aging, Vol. 21, No. 11, 06.10.2004, p. 747-756.

Research output: Contribution to journalArticle

Heifets, Michael ; Saeed, Muhammad I. ; Parikh, Mitten H. ; Sierka, Debra ; Kumar, Mysore S.A. / Induction immunosuppression in kidney transplant recipients older than 60 years of age : Safety and efficacy of ATGAM®, OKT3® and simulect®. In: Drugs and Aging. 2004 ; Vol. 21, No. 11. pp. 747-756.
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