The purpose of this study is to see if kidney function can be improved during transplants by
giving the drug Thymoglobulin with delayed cyclosporine treatment instead of initial
There have been improvements for patients receiving kidney transplants, yet acute rejection
is still a problem. This can lead to kidney failure over time. Patients whose graft fails to
function properly in the first week after transplant do not do as well after 5 years as
compared to patients without early problems. This study will see if Thymoglobulin, a drug
that suppresses the immune system, will improve early graft function.
While graft survival of post renal transplant has improved over the last decades, acute
rejection remains a problem that clinical research has sought to minimize through improved
strategies. Graft survival prognosis is significantly worsened in patients whose allografts
exhibit delayed function and patients may require early dialysis. Data shows that cadaveric
organ recipients requiring dialysis use in the first transplant week have a 5-year
post-graft survival rate of 51 percent compared to 70 percent for those free of this
complication. A recent evaluation of Thymoglobulin (a rabbit-derived polyclonal antibody; an
immunosuppressant) suggests it is an effective agent worthy of further evaluation as
induction therapy. This trial evaluates whether a decreased DGF is seen with an improved Day
90 graft function.
Recipients of a first or second cadaver kidney transplant are randomized pre-transplant to 1
of 2 treatment groups. One group receives antibody therapy (Thymoglobulin) at the time of
transplant and delayed cyclosporine therapy. The other group starts cyclosporine therapy at
the time of transplant without Thymoglobulin. DGF is diagnosed by a less than 20 percent
decrease in the serum creatinine levels in the first 24 hours post-transplant and/or the
need for dialysis. Patients on the antibody arm receive additional antibody if they
experience DGF. Biopsies are performed in all cases of suspected rejection and any patient
with biopsy-confirmed acute cellular rejection receives treatment. Patients have regular
examinations including blood tests and are evaluated for kidney function and incidence of
complications for 24 months after the transplant. The trial endpoint of graft function
encompasses graft survival and graft function as calculated by creatinine clearance.
Patients may be eligible for this study if they:
- Are receiving a first or second kidney transplant.
- Are at least 21 years old.
- Understand the purposes and risks of the study and have given consent.
- Agree to use an acceptable form of birth control for a year following transplant.
Patients will not be eligible for this study if they:
- Have received a kidney transplant from a living donor.
- Have had multiple organ transplants.
- Are allergic to Thymoglobulin (contains a rabbit protein).
- Are pregnant.