Hematologic Adverse Effects of 2 Different Polyclonal Antilymphocyte Preparations in De Novo Kidney Transplant Patients

Abstract

Objectives: To evaluate the hematologic adverse effects of polyclonal antilymphocyte globulins within the first month after surgery in kidney transplant recipients.

Materials and Methods: In this prospective, randomized trial, we included 16 adult-sensitized (panel-reactive antibodies > 30%) recipients of a kidney from a deceased donor. Eight patients received therapy with Genzyme (Thymoglobulin: ATG-G; 6.2 ± 2.9 mg/kg for 7 days), and 8 patients received Fresenius (Lymphoglobulin: ATG-F; 22.6 ± 7.9 mg/kg for 6 days). Other immuno­suppressants included mycophenolate mofetil, tacrolimus, and steroids.

Results: Platelet counts were normal before transplant and significantly reduced after transplant; however, this was more pronounced in ATG-F patients, and had normalized by day 7 in the ATG-G and by day 10 in the ATG-F groups. Mean leukocyte/polymorphonuclear cell counts remained within the normal range in both groups through follow-up. Hemoglobin levels were similar at ~10 g/dL for both groups, up to day 10. However, erythropoietin-stimulating–agent therapy had been given to more patients in the ATG-F group than patients in the ATG-G group. Reticulocyte counts were significantly lower in ATG-F patients by days 3, 5, 7, and 10. From day 14 onwards, reticulocyte counts were similar in both groups. With regard to lymphocyte counts, these were normal in both groups before transplant and then significantly decreased afterward. No patient presented with acute rejection or serum-sickness disease.

Conclusions: Reduced platelet and reticulocyte counts occur more frequently immediately after transplant when using ATG-F compared with ATG-G therapy. Consequently, erythropoietin-stimulating agent therapy was needed more often for ATG-F patients.