Adding thymoglobuline to the conventional immunosuppressant regimen in kidney transplantation: A cost-benefit analysis.

Background: Thymoglobuline (TG), is used for both induction and rejection therapy in kidney transplantation (TX). This study was conducted to compare between adding TG or not to the conventional drugs to evaluate the rate of rejections, infections and costs.

Methods: In two groups of patients, each of 45 cases; group A received conventional drugs (cyclosporine, mycophenolate and prednisolone) and in group B, TG was added; both groups were then compared. TG was administered for 5 doses (1.5 mg/kg/d for the first 3 days and 1 mg/kg/d for the last 2 days. Suspicious signs of rejection (fever, graft tenderness, graft enlargement and increase in length and depth), creatinine rise, diethylene triamine penta-acetic acid scan (DTPA) results and urinary tract infections (UTI) with counts > 10(5) CFU/ml were recorded. The duration of the first hospitalization, the CMV incidence of infection in the first 6 months and their costs were finally compared.

Results: There was no difference for age, duration of hospitalization and CMV infection between the two groups. UTI occurred more frequently in TG group (p=0.049). Creatinine rise, suspicious signs of rejection occurred more frequently in TG group (p<0.05). Creatinine rise and suspicious signs of rejection occurred more frequently in conventional group (p=0.020, p<0.000, respectively). The need for additional steroid pulses was more frequent in conventional group (p<0.000). The total costs of TG, ganciclovir, antibiotics and steroid pulses in both groups were similar.

Conclusion: The results show that the posttransplantation problems (signs of rejection, rise of creatinine, graft losses and delayed graft function) occurred rarely in TG group. The incidence of infection and the cost of both regimens were similar. We strongly recommend this protocol as induction therapy.