Study of Efficacy of Equine Anti Thymocyte Immunoglobulin (Eatg) as Induction and Antirejection Therapeutic Agent in Renal Transplantation

ABSTRACT

BACKGROUND: Equine Anti-Thymocyte Immunoglobulin (eATG) has been used less as an induction immunosuppressant agent in renal transplantation compared to rabbit ATG (rATG). However, eATG is very economical compared to rATG. The cost of eATG as induction agent in renal transplant on an average is INR. 30 000/- per dose, and cost of rabbit ATG ( rATG) as induction agent is INR 1 20 000/-. AIM OF THE STUDY To study the efficacy of eATG as induction and anti-rejection therapeutic agent in renal transplantation. METHOD(S) Material(s) and Method(s) Renal transplant recipients were divided into two groups. Group A (GrA) recipients had renal donation from HLA matched first degree relatives and received only injection methylprednisolone (MP) as induction therapy. Group B (GrB) recipients had renal donation from deceased donors (brain dead) or spousal donors were administered eATG 10 mg/kg along with low dose MP as induction therapy. Outcomes were compared between GrA and GrB. Monitoring for eATG therapy-induced blood lymphocyte count depletion post-transplant was also done to assess eATG efficacy. eATG as antirejection therapy agent eATG was administered in biopsy-proved acute T-cell-mediated rejection (TCMR). Repeat transplant kidney biopsy was done to assess improvement. RESULT(S) Number of renal transplant recipients in GrA were 29 and GrB were 35. All recipients of GrA and GrB had normal renal function by 14th post-transplant day (PTX). There was 20% decrease in blood lymphocyte count following MP therapy (GrA) compared to 85% decrease following therapy with eATG ( GrB) and the difference was statistically significant (p < 0.05). Marked decrease in lymphocyte count indicated efficacy of eATG. Biopsy-proved acute TCMR was seen in 5% of GrA and 4% of GrB (p > 0.05). None from both groups had antibody mediated rejection. All patients with acute TCMR responded to eATG antirejection therapy. Opportunistic infections was noticed in 9% of GrA patients and 11% of GrB patients in the first 180 days PTX (p > 0.05). Two years graft survival was 83% in GrA and 80% in GrB (p > 0.05). During two-year followup one patient from each group died of Covid19 infection (p > 0.05). CONCLUSION(S) Since excellent results were obtained with eATG as an induction and antirejection therapeutic agent, it can be used in renal transplant with high-risk immunological states as a polyclonal antibody. eATG is more economical compared to rATG.