Daclizumab Versus Rabbit Antithymocyte Globulin in High-Risk Renal Transplants: Five-Year Follow-up of a Randomized Study

Am J Transplant. 2015 Jul;15(7):1923-32. doi: 10.1111/ajt.13191. Epub 2015 Feb 23.


We previously reported a randomized controlled trial in which 227 de novo deceased-donor kidney transplant recipients were randomized to rabbit antithymocyte (rATG, Thymoglobulin) or daclizumab if they were considered to be at high immunological risk, defined as high panel reactive antibodies (PRA), loss of a first kidney graft through rejection within 2 years of transplantation, or third or fourth transplantation. Patients treated with rATG had lower incidences of biopsy-proven acute rejection (BPAR) and steroid-resistant rejection at 1 year. Patients were followed to 5 years posttransplant in an observational study; findings are described here. Treatment with rATG was associated with a lower rate of BPAR at 5 years (14.2% vs. 26.0% with daclizumab; p = 0.035). Only one rATG-treated patient (0.9%) and one daclizumab-treated patient (1.0%) developed BPAR after 1 year. Five-year graft and patient survival rates, and renal function, were similar between the two groups. Overall graft survival at 5 years was significantly higher in patients without BPAR (81.0% vs. 54.8%; p < 0.001). In conclusion, rATG is superior to daclizumab for the prevention of BPAR among high-immunological-risk renal transplant recipients. Overall graft survival at 5 years was approximately 70% with either induction therapy, which compares favorably to low-risk cohorts.

Keywords: Immunosuppressant; clinical research/practice; fusion proteins and monoclonal antibodies: basiliximab/daclizumab; graft survival; immunosuppressant; kidney transplantation/nephrology; polyclonal preparations: rabbit antithymocyte globulin.

Publication types

  • Comparative Study
  • Observational Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Animals
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antilymphocyte Serum / therapeutic use*
  • Daclizumab
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Graft Rejection / prevention & control*
  • Graft Survival / drug effects
  • Humans
  • Immunoglobulin G / therapeutic use*
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Failure, Chronic / surgery*
  • Kidney Function Tests
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prognosis
  • Prospective Studies
  • Rabbits
  • Risk Factors


  • Antibodies, Monoclonal, Humanized
  • Antilymphocyte Serum
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Daclizumab