Induction Therapy with Basiliximab versus Thymoglobulin in African-American Kidney Transplant Recipients Abdolreza Haririan, 1,4 Katherina Morawski, 2 Dale H. Sillix, 1 Jose M. El-Amm, 1 James Garnick, 3 Miguel S. West, 1 Darla K. Granger, 2 Stephen D. Migdal, 2 Scott A. Gruber 2 Background. It has been suggested that the use of antilymphocyte induction therapy in African-American (AA) renal transplant recipients reduces the risk of acute rejection (AR) and improves graft survival. It is not clear whether the efficacy of basiliximab (BSX) is different from that of Thymoglobulin (ATG) in this regard. Methods. We retrospectively assessed the effect of induction therapy with BSX versus ATG in 88 AA renal allograft recipients receiving transplants at our center between July 2001 and June 2003 and followed for 197 months. All patients were maintained on mycophenolate mofetil, prednisone, and either tacrolimus or sirolimus. Study endpoints included patient and graft survival, graft function, and incidence of AR and cytomegalovirus infection. Regression models were used to evaluate the independent effect of each induction agent on these endpoints. Results. Thirty-six patients received ATG, and 52 received BSX. The groups were comparable with regard to donor race and age, and recipient sex, body mass index, human leukocyte antigen (HLA) matching, and hepatitis C virus serosta- tus. The ATG group was younger, more likely to receive retransplant, had longer duration of end-stage renal disease and higher panel reactive antibody, and was less likely to receive live-donor organs. However, after adjusting for all these variables, graft outcomes, as well as renal function, were comparable between the two induction groups. We found that the degree of HLA mismatch, delayed graft function, and AR were the only significant predictors of graft loss. Conclusion. The results of our study suggest that the choice of induction agent may not have a major impact on graft outcomes in AA renal-allograft recipients. Keywords: Thymoglobulin, Basiliximab, African-American, Kidney transplantation, Induction. (Transplantation 2005;79: 716 –721) I n recent years, induction therapy has become a standard part of the immunosuppressive regimen for kidney trans- plantation at many centers. Antilymphocyte antibody prepa- rations have long been used for this purpose. In a meta-anal- ysis, Szczech et al. (1), combining individual patient-level data from several reports, concluded that antilymphocyte in- duction for deceased-donor kidney transplantation improves graft outcomes for at least up to 2 years, especially in sensi- tized recipients. Thymoglobulin (ATG) has recently become the antilymphocyte antibody of choice for induction of im- munologically high-risk patients and treatment of high-grade (grades II and III) acute rejection (AR) at many centers (2). This agent is a polyclonal rabbit antibody preparation, with specificity against several lymphocyte markers and adhesion molecules. Concomitantly, monoclonal anti-CD25 prepara- tions have also proved efficacious in reducing the risk of AR when used for induction and have become more widely used, especially in nonsensitized allograft recipients (3, 4). African-American (AA) kidney transplant recipients have been shown to be at higher risk for developing acute and chronic rejection and graft loss when compared with whites (5). Use of induction therapy and newer maintenance immu- nosuppressive agents has been suggested to improve graft outcomes in this population (6–8). Antilymphocyte prepa- rations, including OKT3 and ATG, have often been consid- ered the induction agents of choice for AA recipients. How- ever, it is not clear whether anti-CD25 antibody induction therapy would be less effective. Therefore, we sought to inves- tigate the impact of the choice of induction agent on graft outcomes among AA renal-transplant patients. The indepen- dent effect of the type of induction agent on graft outcomes, after adjusting for multiple confounding factors, was evaluated. METHODS This is a retrospective study of the outcomes of consec- utive adult AA renal-allograft recipients who received trans- plants at our center between June 2001 and July 2003. The study protocol was approved by Wayne State University Hu- man Investigation Committee. Patients who had primary graft failure because of accelerated AR, renal vascular throm- bosis, or death in the perioperative period were excluded from the analysis. All patients received induction therapy with either ATG or basiliximab (BSX), on the basis of recipi- ent risk factors. These included age, panel reactive antibody (PRA), transplant number, and presence or absence of co- morbid conditions, such as cardiovascular disease or hepatitis C virus (HCV) serostatus. ATG was dosed at 1.5 mg/kg per day for 4 to 7 days starting intraoperatively and adjusted as needed for leukopenia or thrombocytopenia, and BSX 20 mg intravenous (IV) was given on days 0 and 4. During the first 1 Division of Nephrology, Department of Medicine, Wayne State University School of Medicine, Detroit, MI. 2 Section of Transplant Surgery, Department of Surgery, Wayne State Uni- versity School of Medicine, Detroit, MI. 3 Pharmacy Department, Harper University Hospital, Detroit, MI. 4 Address correspondence to: Abdolreza Haririan, M.D., 4160 John Rd, Suite 908, Detroit, MI 48201. E-mail: aharirian@med.wayne.edu. Received 13 September 2004. Revision requested 16 October 2004. Accepted 16 November 2004. Copyright © 2005 by Lippincott Williams & Wilkins ISSN 0041-1337/05/7906-716 DOI: 10.1097/01.TP.0000153506.07816.F0 716 Transplantation • Volume 79, Number 6, March 27, 2005