Rabbit Anti-Thymocyte Globulin Versus Basiliximab in Spousal Kidney Transplant: Early Immunological and Clinical Outcomes.

OBJECTIVES: Spousal living donor kidney transplant is commonly performed; however, the optimal induction immunosuppression strategy in recipients with low immunological risk remains unclear. We compared the early clinical and immunological outcomes of low -dose rabbit anti -thymocyte globulin and basiliximab in low -risk spousal kidney transplant recipients.

MATERIALS AND METHODS: We retrospectively analyzed 43 recipients with low immunological risk who underwent spousal living donor kidney transplant and received induction therapy with either rabbit anti -thymocyte globulin (n = 20 ) or basiliximab (n = 23 ). Low immunological risk was defined as first -time transplant with negative panel reactive antibody and negative complement -dependent cytotoxicity crossmatch. Primary endpoints were early graft function, as assessed by serum creatinine trends, and biopsy -proven acute rejection within the first 2 postoperative months. Secondary endpoints included perioperative lymphocyte dynamics and documented infections, including cytomegalovirus and urinary tract infections.

RESULTS: Peripheral blood lymphocyte counts were significantly lower in the group treated with rabbit anti -thymocyte globulin on postoperative day 1 and day 7 versus the basiliximab -treated group (P < .001 ). In contrast, no significant differences were observed between groups in early graft function trajectories (P = .71 ) or the incidence of biopsy-proven acute rejection (rabbit anti -thymocyte globulin, 3 of 20; vs basiliximab, 2 of 23; P > .05 ). All documented urinary tract infections (n =3 ) and the single cytomegalovirus infection occurred in the group treated with rabbit anti -thymocyte globulin; however, these differences were not statistically significant (P > .05 ).

CONCLUSIONS: In spousal kidney transplant recipients with low immunological risk, low -dose rabbit anti -thymocyte globulin (4.5 mg /kg ) and basiliximab provide comparable early graft function and similar protection against acute rejection. Although rabbit anti -thymocyte globulin induces more pronounced lymphocyte depletion, this observation does not translate into superior early clinical outcomes in this patient population.