Daclizumab Versus Thymoglobulin in Renal Transplant Recipients With High Immunological Risk

The objective of this randomized, multi-center trial is to directly compare the ATG, Thymoglobulin, with the anti-CD25 mAb, daclizumab, in a high-risk, HLA-sensitized renal transplant population, in order to elucidate whether there is any significant difference in the incidence of acute rejection after one year.

Eligible patients were randomized (1:1) to receive either ATG (1.25 mg/kg/d from day 0 to day 7) or daclizumab (1 mg/kg at days 0, 14, 28, 42 and 56). Maintenance immunosuppression comprised tacrolimus, MMF and prednisone. The study's primary endpoint was the incidence of biopsy-proven acute rejection at one year.

Inclusion criteria

• Third or fourth renal graft or
• Current anti-HLA antibodies above or equal to 30% at the last evaluation or
• Peak anti-HLA antibodies above or equal to 50% at the last evaluation or
• A second graft if the first was lost within 2 years because of rejection.
• Patients who gave their informed consent and are able to understand the scope of the study

Exclusion criteria

• Transplantation from living donors or recipients of multiple grafts or patients who already have received another (non-renal) allograft.
• Transplantation from a non-heart beating donor
• Transplantation of two kidneys from the same donor
• Patients with generalized infection at the time of transplantation
• Women in child-bearing age who do not plan to use efficient contraception