LOW DOSE RABBIT ANTI-THYMOCYTE GLOBULIN IN OBESE RENAL TRANSPLANT PATIENTS: 8 YEAR FOLLOW UP.

CLINICAL IMMUNOSUPPRESSION - KIDNEY LATE

M.R. Laftavi¹, S.K. Patel², R. Kohli³, M. Alnimri², M. Said², L. Feng², H. Laftavi², O. Pankewycz^2
1Surgery, SUNY at Buffalo, Buffalo/New york/UNITED STATES OF AMERICA, ²Surgery, SUNY at Buffalo, BUFFALO/UNITED STATES OF AMERICA, ³Medicine, SUNY at Buffalo, BUFFALO/UNITED STATES OF AMERICA

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Introduction: Obesity is a burgeoning problem among renal transplant recipients given its association with increased morbidity, graft loss and mortality. The long-term influence of different induction therapies in obese compared to non-obese patients (pt) is uncertain. We now examine the long-term effect of low dose rabbit antithymocyte globulin 3-5 mg/kg total dose (rATG) induction therapy compared to 2 doses of 20 mg basiliximab (BSX) in non-obese and obese renal transplant recipients. Methods: The medical records of all adult (>18 yrs.) recipients of renal transplant between 6/01 and 6/09 in our center were reviewed. Pts whose BMI was >30 were considered to be obese. The average dose of rATG was 3.2±1.6 mg/kg. Results: A total of 475 pts were included. In the non-obese group with a BMI<30, 68 received BSX and 247 rATG. In the obese group 27 pts were given BSX and 133 were given rATG. Mean follow up was 1523 days. These 4 groups were similar in baseline characteristics including: donor and recipient age, percent diabetes, living donors, PRA>35, HLA MM, race, gender and maintenance immunosuppression. Serum creatinine levels at 3 mos., 1, 5 and 7 yrs. were not statistically different between groups. Viral infection rates were not statistically different between rATG and BSX groups.

Groups	Pt. Survival	Graft Survival**	Rejection 1A	Borderline Rejection	Wound Infection	Cancer
BSX BMI<30	86.8%	68.2%	19.1%	31.8%	0.9%	0
rATG BMI<30	91.1%	88.7%*	2.8%*	21.7%*	1.2%	2
BSX BMI>30	81.5%	63.6%	0%	18.2%	3.7%	0
rATGBMI>30	91%	90.3%*	6.8%	29%	4.4%	0

*p<0.05 vs. BSX, ** Death Censored Conclusion: In summary, low dose rATG is associated with a better long-term graft survival rates in obese pts compared to BSX induction. When rATG is used in obese and non-obese pts, there was no difference in long-term outcomes.

Disclosure: All authors have declared no conflicts of interest.