M. V. K. Hareesh, R. K. Sharma
BACKGROUND Renal transplantation is the best available form of renal replacement therapy. Induction therapy pre-transplant reduces the incidence of graft rejections. We present a retrospective study comparing different induction methods in living donor kidney transplantation in our institute. MATERIALS AND METHODS We analysed 423 live kidney transplant recipients of our center from Dec 2010 to Nov 2015, 344 of whom received basiliximab as induction and 79 r-ATG as induction. Primary outcomes like patient survival and graft survival, secondary outcomes like graft rejections, infections, PTDM, recurrence of disease were compared. RESULTS 5yr patient survival rates were observed to be 91% and 88% respectively whereas graft survival rates were 93% and 86% respectively for ATG and basiliximab. Incidence of rejections was similar (p=0.867). Cellular rejections were more common with basiliximab (7.9% vs. 3.8%) but statistically not significant (P=0.498). Infections in the post-operative period were more common in r-ATG arm especially LRTI (P=0.011) and diarrhoeal episodes (P=0.005). Incidence of cytopenias was more in r- ATG arm during hospital stay (10.1 vs. 2.6% P=0.002) and also the later followup period (25 vs. 12.4% P<0.001). Incidence of PTDM was more in basiliximab (33.8% vs. 22.8%) arm but not significant (P=0.061). CONCLUSION ATG and basiliximab are non-inferior to one another as induction therapy. ATG is effective in high immunological risk groups with equivalent graft and patient survival with increased risk of Lower respiratory tract infections and diarrhoea in immediate post-transplant periods and increased risk for cytopenias compared to basiliximab. Basiliximab has slightly increased risk of post-transplant diabetes mellitus. Careful selection of the agent in an individual based on risk rather than a question of efficacy of agents is the key to successful transplantation.
