Grafalon® vs. thymoglobulin® as an induction agent in renal transplantation – A retrospective study
Pranaw Kumar Jha1, Abhyudaysingh Rana1, Ajay Kher2, Shyam Bihari Bansal1, Sidharth Sethi1, Ashish Nandwani1, Manish Jain1, Dinesh Bansal1, Dinesh Kumar Yadav1, Ashwini Gadde1, Amit Kumar Mahapatra1, Puneet Sodhi1, Vijay Kher1
1 Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta – The Medicity, Sector 38, Gurugram, Haryana, India
2 Department of Nephrology, Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India
Pranaw Kumar Jha,
Department of Nephrology, Medanta – The Medicity, Sector-38, Gurugram - 122 001, Haryana
Source of Support: None, Conflict of Interest: None
Introduction: Antihuman thymocyte immunoglobulin, used as an induction agent in renal transplantation, is of two types – thymoglobulin and grafalon (formerly ATG-Fresenius). In this study, we compared outcomes with these two agents. Methods: This was a single-center retrospective study of patients transplanted from January 2017 to October 2019, who received either grafalon or thymoglobulin induction. Grafalon or thymoglobulin was given at 6 and 3 mg/kg, respectively, followed by standard triple immunosuppression of tacrolimus, MMF, and prednisolone. Results: Median follow up was 22 (3–36) months. Thymoglobulin was given to 255 patients, whereas 78 patients received grafalon. Baseline demographics were similar between the two groups although significantly more patients in the grafalon group received ABO incompatible transplant (15% vs. 4.3%; P = 0.002). Patient survival was similar between the two groups (99% in grafalon vs. 98.8% in thymoglobulin; P = 1.0). Death censored graft survival was also similar (99% in grafalon vs. 100% in thymoglobulin; P = 0.23). Biopsy proven acute rejection (BPAR) was significantly higher in the grafalon group (12.8% vs. 5.1%, P = 0.04). The significance persisted after multivariable regression analysis (P = 0.02). Other outcomes such as infection rate and estimated glomerular filtration rate on last follow up were comparable between the two groups. Conclusions: Grafalon (6 mg/kg dose) when used as an induction agent was associated with significantly higher rate of BPARs as compared to thymoglobulin (3 mg/kg dose) although with comparable short-term patient and death censored graft survival, graft function, and infection rates.