Initial Experience with Grafalon as Induction Agent in Kidney Transplantation

Introduction: Renal transplantation is ideal modality of Renal Replacement Therapy (RRT) as it is cost effective and associated with quality of life. Induction immunosuppression is an immunosuppressive therapy given at the time of transplantation to reduce risk of acute rejection. Induction agents include lymphocyte depleting antibodies and Interleukin-2 (IL2) receptor antagonists. Commonly used lymphocyte depleting antibodies are ‘Thymoglobulin’ and ‘Grafalon’. There is no study with Grafalon as induction agent in renal transplantation from India, as until recently it was unavailable in India. Current study is the first report from India, of Grafalon use as an induction agent in renal transplantation. Aim: The aim of the present study was, to study safety and efficacy of ‘Grafalon’ as induction agent in kidney transplantation. Materials and Methods: This was a single center study of 11 patients who have received Grafalon as induction agent for renal transplantation. All received steroid pulse and Grafalon 4 mg/ kg as induction. Maintenance immunosuppression consisted of prednisolone, tacrolimus and mycophenolate sodium. Results: Four patients (36.3%; 95% Confidence Interval (CI), 8 to 65%) developed biopsy proven acute rejection. Three patients had combined acute T-cell and acute antibody mediated rejection and one had acute T-cell mediated rejection. One patient died due to rhinocerebral mucormycosis and one graft was lost due to graft thrombosis. Two patients got urinary tract infection, one with wound infection and another one developed cytomegalovirus syndrome. Cost of Grafalon induction (4 mg/ kg) was higher compared to Thymoglobulin (1.5 mg/kg). Conclusion: Induction with Grafalon was associated with high rate of acute rejection, at the dosage used in the present study. So, cannot be recommended in clinical practice at this dose.