Does Rabbit Antithymocyte Globulin (Thymoglobuline®) Have a Role in Avoiding Delayed Graft Function in the Modern Era of Kidney Transplantation?

Table 2

Randomized clinical trials of rATG versus IL-2RA induction in adult kidney transplant recipients. Induction and maintenance therapies were started after procedure on the day of transplantation unless otherwise stated.

Study	Population	n	rATG regimen	IL-2RA regimen	DGF (rATG vs IL-2RA)	BPAR (rATG vs IL-2RA)	Other findings (rATG vs IL-2RA)
Thomusch et al., 2016 [65]	Low immunological risk (including no pretransplant DSA, PRA ≤30%)		rATG (1.5 mg/kg intraoperatively, 1.5 mg/kg x 3 to day 3); Immediate low-; dose TAC; MMF; Steroids to day 8	Basiliximab (20 mg/kg intraoperatively, 20 mg day 4); Immediate low-; dose TAC; MMF; Steroids to day 8	Not stated	9.9% vs 10.6% (p=0.87)	-
Pilch et al., 2014 [66]	Unselected (other than ABO compatible)	200	rATG (5 x 1.5 mg/kg); Immediate TAC; MMF; Steroids	Daclizumab (2 x 1 mg/kg); Immediate TAC; MMF; Steroids	9% vs 10%; (p=0.81)	Month 6: 2% versus 8% (p=0.05)	Mean time to BPAR by month 12: 98 vs 241 days (p<0.001)
Noël et al., 2009 [50]	High immunological risk (including PRA ≥30% or peak PRA ≥50%), no positive T-cell cross-match or DCD	227	rATG (1.25 mg intraoperatively and on days 1- 7); TAC from day 2-5; MMF; Steroids	Daclizumab (5 x 1 mg/kg); Immediate TAC; MMF; Steroids	31.5% vs 44.6% (p=0.044)	Month 12: 15.5% vs 27.2% (p=0.016)	Steroid-resistant BPAR at month 12: 2.7% vs 14.9% (p=0.002)
Abou-Ayache et al., 2008 [54]	Low or moderate immunological risk (including CIT ≤36 hours, PRA ≤20%), deceased donor	113	rATG (dose adjusted based on CD2/CD3 count); CsA started by day 7 (or earlier depending on graft function); MMF; Steroids	Daclizumab (2 mg/kg pretransplant, 1 mg/kg on day 14); CsA started by day 7 (or earlier depending on graft function); MMF; Steroids	12.7% vs 18.5%	Month 12; 14.5% vs 16.7% (n.s.)	Mean time to BPAR by month 12: 82 vs 133 days (n.s.)
Brennan et al., 2006 [49]	High risk for acute rejection or BPAR	278	rATG (1.5 mg/kg intraoperatively, then 1.5 mg/kg x 4); CsA started by day 4 (or earlier depending on graft function); MMF; Steroids	Basiliximab (2 x 20 mg); CsA started by day 4 (or earlier depending on graft function); MMF; Steroids	40.4% vs 44.5% (p=0.54)	Month 12: 15.6% vs 25.5% (p=0.02)	Steroid-resistant BPAR at month 12: 1.4% vs 8.0% (p=0.005)
Mourad et al., 2004 [52]	Low or moderate immunological risk (including PRA ≤20%), deceased donor	105	rATG (1 mg/kg on days 0 and 1, then based on CD3 count); CsA according to renal function; MMF; Steroids	Basiliximab (2 x 20mg); CsA according to renal function; MMF; Steroids	30.2% vs 28.8%	Month 12: 9.4% vs 9.6% (n.s.)	Significantly more; frequent CMV infections, leukopenia and thrombocytopenia; with rATG vs basiliximab
Lebranchu et al., 2002 [51]	Low or moderate immunological risk (including CIT ≤36 hours, PRA ≤25%, no T-cell cross-match)	100	rATG (dose adjusted based on CD2/CD3 count); CsA (started based on graft function); MMF; Steroids	Basiliximab (2 x 20mg); Immediate CsA; MMF; Steroids	6% vs 14%^†	Month 12: 8.0% vs 8.5% (n.s.)	Significantly more frequent CMV infections with rATG vs basiliximab

third treatment group comprised basiliximab with low-dose TAC, MMF, and steroid maintenance therapy (data not shown).
p value provided.
to basiliximab (2 x 20 mg) after withdrawal of daclizumab from the market.
on duration of cold ischemia time and predefined donor/recipient risk factors.
BPAR, biopsy-proven acute rejection; CIT, cold ischemia time; CMV, cytomegalovirus; CsA, cyclosporine; DCD, donation after circulatory death; DGF, delayed graft function; DSA, donor-specific antibodies; IL-2RA, interleukin-2 receptor antagonist; MMF, mycophenolate mofetil; n.s., not significant; PRA, panel reactive antibodies; rATG, rabbit antithymocyte globulin; TAC, tacrolimus.