Adem ŞAFAK, Emre KARAKAYA, Ahmed USLU, Nedim ÇEKMEN, Turan ÇOLAK, Sedat YILDIRIM, Mehmet HABERAL
Experimental and Clinical Transplantation - 2026;24(7):522-527
Objectives: Spousal living donor kidney transplant is commonly performed; however, the optimal induction immunosuppression strategy in recipients with low immunological risk remains unclear. We compared the early clinical and immunological outcomes of low-dose rabbit anti-thymocyte globulin and basiliximab in low-risk spousal kidney transplant recipients. Materials and Methods: We retrospectively analyzed 43 recipients with low immunological risk who underwent spousal living donor kidney transplant and received induction therapy with either rabbit anti-thymocyte globulin (n = 20) or basiliximab (n = 23). Low immunological risk was defined as first-time transplant with negative panel reactive antibody and negative complement-dependent cytotoxicity crossmatch. Primary endpoints were early graft function, as assessed by serum creatinine trends, and biopsy-proven acute rejection within the first 2 postoperative months. Secondary endpoints included perioperative lymphocyte dynamics and documented infections, including cytomegalovirus and urinary tract infections. Results: Peripheral blood lymphocyte counts were significantly lower in the group treated with rabbit anti-thymocyte globulin on postoperative day 1 and day 7 versus the basiliximab-treated group (P < .001). In contrast, no significant differences were observed between groups in early graft function trajectories (P = .71) or the incidence of biopsy-proven acute rejection (rabbit anti-thymocyte globulin, 3 of 20; vs basiliximab, 2 of 23; P > .05). All documented urinary tract infections (n = 3) and the single cytomegalovirus infection occurred in the group treated with rabbit anti-thymocyte globulin; however, these differences were not statistically significant (P > .05). Conclusions: In spousal kidney transplant recipients with low immunological risk, low-dose rabbit anti-thymocyte globulin (4.5 mg/kg) and basiliximab provide comparable early graft function and similar protection against acute rejection. Although rabbit anti-thymocyte globulin induces more pronounced lymphocyte depletion, this observation does not translate into superior early clinical outcomes in this patient population.
