Induction therapy: clinical and quality of life outcomes in aged renal transplant recipients

Clin Transplant. 2015 Mar;29(3):222-6. doi: 10.1111/ctr.12507. Epub 2015 Jan 27.


Background: One primary purpose of transplant is to improve quality of life (QOL) in renal transplant recipients (RTRs) ≥ 50 yr of age, where death with a functioning graft limits life years gained. We aimed to determine the impact of induction therapy, with its subsequent effects on rejection, infection, and readmissions, on QOL.

Methods: Subanalysis of patients ≥ 50 yr of age that participated in a single-center, prospective, risk-stratified, randomized, open-label study. Two hundred RTRs ≥ 50 yr of age.

Interventions: All patients received either rabbit antithymocyte globulin (rATG) or interleukin 2 receptor antagonists (IL-2RA) in addition to tacrolimus (FK), mycophenolate mofetil (MMF), and corticosteroids in a randomized fashion. Outcome analyses included safety, efficacy, and QOL.

Results: Results reported 1 yr post-transplant. Of 111 patients ≥ 50 yr old, 48 received IL-2RA and 63 received rATG. Baseline characteristics were similar between groups. Patients that received rATG had a trend toward lower acute rejection rates, fewer readmissions, and fewer supratherapeutic tacrolimus troughs, with similar rates of infections. QOL analysis demonstrated patients that received rATG were significantly more likely to have improvements in physical and social functioning after transplant.

Conclusions: Contrary to the common practice, T-cell depletion in recipients ≥ 50 yr of age may be beneficial.

Trial registration: NCT00859131.

Keywords: induction therapy; interleukin-2 receptor antagonist; kidney transplant; quality of life; rabbit antithymocyte globulin.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Animals
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antilymphocyte Serum / therapeutic use
  • Daclizumab
  • Drug Therapy, Combination
  • Female
  • Graft Rejection / prevention & control*
  • Humans
  • Immunoglobulin G / therapeutic use
  • Immunosuppressive Agents / therapeutic use*
  • Induction Chemotherapy / methods*
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Patient Readmission / statistics & numerical data
  • Prospective Studies
  • Quality of Life
  • Rabbits
  • Tacrolimus / therapeutic use
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal, Humanized
  • Antilymphocyte Serum
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Daclizumab
  • Mycophenolic Acid
  • Tacrolimus

Associated data