Guia prático para usar Thymoglobuline<sup>®</sup> (globulina antitimócito) em transplante renal

Castro, Maria Cristina Ribeiro de; Deboni, Luciane; Esmeraldo, Ronaldo de Matos; Matuk, Tereza Azevedo; Pacheco, Alvaro; Saitovitch, David; Salomão, Abrahão; Silva Junior, Helio Tedesco; Villaça, Sandra

doi:10.5935/0101-2800.20150036

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Brasil

Brazilian Journal of Nephrology

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Sumário

Artigos de Revisão • J. Bras. Nefrol. 37 (2) • Apr-Jun 2015 • https://doi.org/10.5935/0101-2800.20150036 copiar

Guia prático para usar Thymoglobuline^® (globulina antitimócito) em transplante renal

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

A combinação de imunossupressores faz parte do protocolo de tratamento de pacientes submetidos a um transplante renal (TR). A Thymoglobuline^®, imunoglobulina policlonal de coelho dirigida contra timócitos humanos, é o agente mais usado como terapia de indução no TR nos Estados Unidos. No Brasil, a Thymoglobuline^® está aprovada para uso em pacientes que foram submetidos a transplante e, apesar de ser amplamente utilizada, ainda existem controvérsias em relação ao seu modo de uso. Realizamos uma revisão sistemática da literatura avaliando os estudos que utilizaram a Thymoglobuline^® na indução e no tratamento de rejeição em pacientes submetidos ao TR. A revisão utilizou os bancos de dados computadorizados da EMBASE, LILACS e MedLine e dos trabalhos selecionados foram extraídas informações sobre os dados gerais dos pacientes, as características metodológicas e as variáveis analisadas em cada estudo. Dos resultados obtidos, desenvolvemos um guia prático sobre o uso de Thymoglobuline^® em pacientes transplantados renais.

Palavras-chave:
imunoglobulinas intravenosas; soro antilinfocitário; transplante de rim

Estudo	Razões para exclusão
Chaparro et al. 2009³⁹39 Chaparro A, Monteverde M, Ibañez J, Adragna M, Lopez L, Briones L, et al. Trasplante renal 1988 - 2008. Med Infant 2009;16:118-25.	Não randomizado
Díaz et al. 2008⁴⁰40 Díaz JM, Cabera C, Facundo C, Guirado L, Maderuelo A, Silva I, et al. Evolución de los pacientes trasplantados con riñones procedentes de donantes en asistolia. Actas Fund Puigvert 2008;27:127-30.	Não randomizado
Kuypers et al.2005⁴¹41 Kuypers DR, Malaise J, Claes K, Evenepoel P, Maes B, Coosemans W, et al.; Euro-SPK Study Group. Secondary effects of immunosuppressive drugs after simultaneous pancreas-kidney transplantation. Nephrol Dial Transplant 2005;20:33-9.	Transplante rim/pâncreas
Mehrabi et al. 2007⁴²42 Mehrabi A, Mood ZhA, Sadeghi M, Schmied BM, Müller SA, Welsch T, et al. Thymoglobulin and ischemia reperfusion injury in kidney and liver transplantation. Nephrol Dial Transplant 2007;22:viii54-viii60. DOI: http://dx.doi.org/10.1093/ndt/gfm651 http://dx.doi.org/10.1093/ndt/gfm651...	Não randomizado
Agha et al. 2002⁴³43 Agha IA, Rueda J, Alvarez A, Singer GG, Miller BW, Flavin K, et al. Short course induction immunosuppression with thymoglobulin for renal transplant recipients. Transplantation 2002;73:473-5. DOI: http://dx.doi.org/10.1097/00007890-200202150-00025 http://dx.doi.org/10.1097/00007890-20020...	Não randomizado
Moura et al. 2006⁴⁴44 Moura LRR, Pereira MG, Durão M, Tomato EJ, Matos ACC, Wroclawski ER, et al. Imunoglobulina antitimócito como terapia de indução: proteção contra a lesão de isquemia e reperfusão. Einstein (São Paulo) 2006;4:315-20.	Não randomizado
Nicoluzzi et al. 2010⁴⁵45 Nicoluzzi JE, Silveira F, Silveira FP, Macri M. Experience with 100 pancreas transplants. Rev Col Bras Cir 2010;37:102-5. DOI:http://dx.doi.org/10.1590/S0100-69912010000200006 http://dx.doi.org/10.1590/S0100-69912010...	Transplante pâncreas
Sampaio et al. 2010⁴⁶46 Sampaio ELM, Freitas TVD, Galante NZ, Park SI, Harada KM, Haolla FAB, et al. Terapia de indução com alentuzumabe em receptores de transplante renal. J Bras Nefrol 2010;32:91-9. DOI: http://dx.doi.org/10.1590/S0101-28002010000100015 http://dx.doi.org/10.1590/S0101-28002010...	Não randomizado
Sancho et al. 2 0 06⁴⁷47 Sancho A, Gavela E, Crespo JF, Górriz JL, Ávila A, Núñez A, et al. Renal transplantation with positive cross-matching test. Nefrologia 2006;26:261-6.	Não randomizado
Laftavi et al. 2011⁴⁸48 Laftavi MR, Patel S, Soliman MR, Alnimri M, Kohli R, Said M, et al. Low-dose thymoglobulin use in elderly renal transplant recipients is safe and effective induction therapy. Transplant Proc 2011;43:466-8. PMID: 21440735 DOI: http://dx.doi.org/10.1016/j.transproceed.2011.01.039 http://dx.doi.org/10.1016/j.transproceed...	Não randomizado
Anil Kumar et al. 2008⁴⁹49 Anil Kumar MS, Irfan Saeed M, Ranganna K, Malat G, Sustento-Reodica N, Kumar AM, et al. Comparison of four different immunosuppression protocols without long-term steroid therapy in kidney recipients monitored by surveillance biopsy: five-year outcomes. Transpl Immunol 2008;20:32-42. DOI: http://dx.doi.org/10.1016/j.trim.2008.08.005 http://dx.doi.org/10.1016/j.trim.2008.08...	Não avaliou Imunoglobulina antitimócito
Ciancio et al. 2008⁵⁰50 Ciancio G, Burke GW, Gaynor JJ, Roth D, Sageshima J, Kupin W, et al. Randomized trial of mycophenolate mofetil versus enteric-coated mycophenolate sodium in primary renal transplant recipients given tacrolimus and daclizumab/thymoglobulin: one year follow-up. Transplantation 2008;86:67-74.	Não avaliou Imunoglobulina antitimócito
Buchler et al. 2007⁵¹51 Büchler M, Caillard S, Barbier S, Thervet E, Toupance O, Mazouz H, et al.; SPIESSER Group. Sirolimus versus cyclosporine in kidney recipients receiving thymoglobulin, mycophenolate mofetil and a 6-month course of steroids. Am J Transplant 2007;7:2522-31. DOI:http://dx.doi.org/10.1111/j.1600-6143.2007.01976.x http://dx.doi.org/10.1111/j.1600-6143.20...	Não avaliou Imunoglobulina antitimócito
Aoun et al. 2007⁵²52 Aoun M, Eschewege P, Hamoudi Y, Beaudreuil S, Duranteau J, Cheisson G, et al. Very early steroid withdrawal in simultaneous pancreas-kidney transplants. Nephrol Dial Transplant 2007;22:899-905. DOI: http://dx.doi.org/10.1093/ndt/gfl660 http://dx.doi.org/10.1093/ndt/gfl660...	Transplante rim/pâncreas
Bogetti et al. 2005⁵³53 Bogetti D, Sankary HN, Jarzembowski TM, Manzelli A, Knight PS, Thielke J, et al. Thymoglobulin induction protects liver allografts from ischemia/reperfusion injury. Clin Transplant 2005;19:507-11. DOI: http://dx.doi.org/10.1111/j.1399-0012.2005.00375.x http://dx.doi.org/10.1111/j.1399-0012.20...	Transplante hepático
Hardinger et al. 2005⁵⁴54 Hardinger KL, Bohl DL, Schnitzler MA, Lockwood M, Storch GA, Brennan DC. A randomized, prospective, pharmacoeconomic trial of tacrolimus versus cyclosporine in combination with thymoglobulin in renal transplant recipients. Transplantation 2005;80:41-6. PMID: 16003231 DOI:http://dx.doi.org/10.1097/01.TP.0000162980.68628.5A http://dx.doi.org/10.1097/01.TP.00001629...	Não avaliou Imunoglobulina antitimócito
Lo et al. 2004⁵⁵55 Lo A, Egidi MF, Gaber LW, Shokouh-Amiri MH, Nazakatgoo N, Fisher JS, et al. Observations regarding the use of sirolimus and tacrolimus in high-risk cadaveric renal transplantation. Clin Transplant 2004;18:53-61. DOI: http://dx.doi.org/10.1111/j.1399-0012.2004.00116.x http://dx.doi.org/10.1111/j.1399-0012.20...	Não avaliou Imunoglobulina antitimócito
Stegall et al. 2003⁵⁶56 Stegall MD, Larson TS, Prieto M, Gloor J, Textor S, Nyberg S, et al. Kidney transplantation without calcineurin inhibitors using sirolimus. Transplant Proc 2003;35:125S-7S. DOI: http://dx.doi.org/10.1016/S0041-1345(03)00226-4 http://dx.doi.org/10.1016/S0041-1345(03)...	Não avaliou Imunoglobulina antitimócito
Kim et al. 2012⁵⁷57 Kim JM, Jang HR, Ko JS, Kwon CH, Kwak MS, Hur WS, et al. Comparison between thymoglobulin and ATGAM as an induction agent in adult kidney transplantation: a single-center experience. Transplant Proc 2012;44:171-4. DOI: http://dx.doi.org/10.1016/j.transproceed.2011.11.061 http://dx.doi.org/10.1016/j.transproceed...	Não randomizado
LaMattina et al. 2012⁵⁸58 LaMattina JC, Mezrich JD, Hofmann RM, Foley DP, D'Alessandro AM, Sollinger HW, et al. Alemtuzumab as compared to alternative contemporary induction regimens. Transpl Int 2012;25:518-26. DOI: http://dx.doi.org/10.1111/j.1432-2277.2012.01448.x http://dx.doi.org/10.1111/j.1432-2277.20...	Não randomizado
Ciancio et al. 2011⁵⁹59 Ciancio G, Gaynor JJ, Sageshima J, Guerra G, Zarak A, Roth D, et al. Randomized trial of dual antibody induction therapy with steroid avoidance in renal transplantation. Transplantation 2011;92:1348-57. PMID: 22027927 DOI: http://dx.doi.org/10.1097/TP.0b013e3182384b21 http://dx.doi.org/10.1097/TP.0b013e31823...	Não avaliou Imunoglobulina antitimócito
Hourmant et al. 1994⁶⁰60 Hourmant M, Le Mauff B, Cantarovich D, Dantal J, Baatard R, Denis M, et al. Prevention of acute rejection episodes with an anti-interleukin 2 receptor monoclonal antibody. II. Results after a second kidney transplantation. Transplantation 1994;57:204-7. PMID: 8310508 DOI:http://dx.doi.org/10.1097/00007890-199401001-00008 http://dx.doi.org/10.1097/00007890-19940...	Não randomizado
Martin et al. 2011⁶¹61 Martin ST, Roberts KL, Malek SK, Tullius SG, Vadivel N, De Serres S, et al. Induction treatment with rabbit antithymocyte globulin versus basiliximab in renal transplant recipients with planned early steroid withdrawal. Pharmacotherapy 2011;31:566-73. DOI: http://dx.doi.org/10.1592/phco.31.6.566 http://dx.doi.org/10.1592/phco.31.6.566...	Não randomizado
Thielke et al. 2005⁶²62 Thielke J, DeChristopher PJ, Sankary H, Oberholzer J, Testa G, Benedetti E. Highly successful living donor kidney transplantation after conversion to negative of a previously positive flow-cytometry cross-match by pretransplant plasmapheresis. Transplant Proc 2005;37:643-4. PMID: 15848486 DOI:http://dx.doi.org/10.1016/j.transproceed.2004.12.063 http://dx.doi.org/10.1016/j.transproceed...	Não randomizado
Ulrich et al. 2011⁶³63 Ulrich F, Niedzwiecki S, Pascher A, Kohler S, Weiss S, Fikatas P, et al. Long-term outcome of ATG vs. Basiliximab induction. Eur J Clin Invest 2011;41:971-8. DOI: http://dx.doi.org/10.1111/j.1365-2362.2011.02490.x http://dx.doi.org/10.1111/j.1365-2362.20...	Não randomizado

	Tipo de estudo	Comparação	N	Taxa de rejeição aguda	Taxa de lesão crônica	Função retardada do enxerto	Sobrevida (+ 6-12 meses)	Sobrevida do enxerto (+ 6-12 meses)	Taxa de perda do enxerto
Ciancio et al. 2010⁶⁴64 Ciancio G, Gaynor JJ, Roth D, Kupin W, Hanson L, Tueros L, et al. Randomized trial of thymoglobulin versus alemtuzumab (with lower dose maintenance immunosuppression) versus daclizumab in living donor renal transplantation. Transplant Proc 2010;42:3503-6. PMID: 21094804 DOI:http://dx.doi.org/10.1016/j.transproceed.2010.08.045 http://dx.doi.org/10.1016/j.transproceed...	RCT doadores vivos	Imunoglobulina antitimócito vs.	13	0 (0%)	0 (0%)	2 (15,3%)	NR	NR	0 (0%)
		Imunoglobulina antitimócito vs.	13	1 (7,69%)	3 (23,%)	0 (0%)			0 (0%)
		Alemtuzumabe vs. Daclizumabe	12	1 (8,33%)	0 (0%)	0 (0%)			0 (0%)
		Alemtuzumabe vs. Daclizumabe			p = 0,01
Brennan et al. 1999²¹21 Brennan DC, Flavin K, Lowell JA, Howard TK, Shenoy S, Burgess S, et al. A randomized, double-blinded comparison of Thymoglobulin versus Atgam for induction immunosuppressive therapy in adult renal transplant recipients. Transplantation 1999;67:1011-8. PMID: 10221486 DOI:http://dx.doi.org/10.1097/00007890-199904150-00013 http://dx.doi.org/10.1097/00007890-19990...	RCT doadores falecidos	Imunoglobulina antitimócito vs. Atgam	48	2 (4,2%)	NR	1/72 (1%)	47 (98%)	47 (98%)	0 (0%)
							23 (96%)	20 (83%)	3 (13%)
			24	6 (25%)			p = 0,606	p = 0,020
				p = 0,014
Brennan et al. 2006¹³13 Brennan DC, Daller JA, Lake KD, Cibrik D, Del Castillo D; Thymoglobulin Induction Study Group. Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med 2006;355:1967-77. DOI: http://dx.doi.org/10.1056/NEJMoa060068 http://dx.doi.org/10.1056/NEJMoa060068...	RCT doadores falecido	Imunoglobulina antitimócito vs. Basiliximabe	141	22 (15,6%)	NR	57 (40,4%)	135 (95,7%)	128 (90,8%)	13 (9,2%)
							131 (95,6%)	123 (89,8%)	14 (10,2%)
			137	35 (25,5%)	NR	61 (45,5%)	p = 0,90		p = 0,68
				p = 0,02		p = 0,54
Noèl et al. 2009⁸8 Noël C, Abramowicz D, Durand D, Mourad G, Lang P, Kessler M, et al. Daclizumab versus antithymocyte globulin in high-immunological-risk renal transplant recipients. J Am Soc Nephrol 2009;20:1385-92. DOI: http://dx.doi.org/10.1681/ASN.2008101037 http://dx.doi.org/10.1681/ASN.2008101037...	RCT doadores falecidos	Imunoglobulina antitimócito vs. Daclizumabe	113	17 (15%)	NR	35 (31,5%)	108 (95,6%)	93 (82,3%)	20 (17,7%)
							110 (96,5%)	98 (86,0%)	16 (14%)
			114	31 (27,2%)		50 (44,6%)	p = 0,75	p = 0,47	p = 0,47
				p = 0,016		p = 0,044
Mourad et al. 2 0 04²³23 Mourad G, Rostaing L, Legendre C, Garrigue V, Thervet E, Durand D. Sequential protocols using basiliximab versus antithymocyte globulins in renal-transplant patients receiving mycophenolate mofetil and steroids. Transplantation 2004;78:584-90. PMID: 15446319 DOI:http://dx.doi.org/10.1097/01.TP.0000129812.68794.CC http://dx.doi.org/10.1097/01.TP.00001298...	RCT, doadores falecidos ou vivos	Imunoglobulina antitimócito vs. Basiliximabe	53	5 (9,4%)	NR	16 (30%)	51 (98,1%)	50 (96,2%)	2 (3,8%)
							52 (98,1%)	50 (94,2%)	2 (3,9%)
			52	5 (9,6%)		15 (28%)
Abou-Ayache et al. 2008²⁶26 Abou-Ayache R, Büchler M, Lepogamp P, Westeel PF, Le Meur Y, Etienne I, et al. CMV infections after two doses of daclizumab versus thymoglobulin in renal transplant patients receiving mycophenolate mofetil, steroids and delayed cyclosporine A. Nephrol Dial Transplant 2008;23:2024-32. DOI: http://dx.doi.org/10.1093/ndt/gfm873 http://dx.doi.org/10.1093/ndt/gfm873...	RCT doadores falecidos	Imunoglobulina antitimócito vs. Daclizumabe	55	8 (14,5%)	NR	20 (36%)	54 (98%)	52 (95%)	NR
							53 (98%)	51 (94%)
			54	9 (16,7%)		17 (32%)
				p = NS
Ciancio et al. 2005/2008²⁷27 Ciancio G, Burke GW, Gaynor JJ, Carreno MR, Cirocco RE, Mathew JM, et al. A randomized trial of three renal transplant induction antibodies: early comparison of tacrolimus, mycophenolate mofetil, and steroid dosing, and newer immune-monitoring. Transplantation 2005;80:457-65. PMID: 16123718 DOI: http://dx.doi.org/10.1097/01.tp.0000165847.05787.08 http://dx.doi.org/10.1097/01.tp.00001658... ^,⁶⁵65 Ciancio G, Burke GW, Gaynor JJ, Roth D, Kupin W, Rosen A, et al. A randomized trial of thymoglobulin vs. alemtuzumab (with lower dose maintenance immunosuppression) vs. daclizumab in renal transplantation at 24 months of follow-up. Clin Transplant 2008;22:200-10. DOI:http://dx.doi.org/10.1111/j.1399-0012.2007.00774.x http://dx.doi.org/10.1111/j.1399-0012.20...	RCT doadores falecidos	Imunoglobulina antitimócito vs. Alemtuzumabe vs. Daclizumabe	30	6 (17%)	5 (14%)	4 (13,3%)	25 (85%)	24 (81%)	1 (3,33%)
							26 (88%)	22 (74%)	6 (20%)
			30	7 (24%)	11 (37%)	2 (6,7%)	25 (85%)	24 (82%)	1 (3,33%)
							p = 0,89	p = 0,66
			30	7 (25%)	3 (11%)	2 (6,7%)
					p = 0,02	p = 0,58
Khosroshahi et al. 2008¹¹11 Khosroshahi HT, Tubbs RS, Shoja MM, Ghafari A, Noshad H, Ardalan MR. Effect of prophylaxis with low-dose anti-thymocyte globulin on prevention of acute kidney allograft rejection. Transplant Proc 2008;40:137-9. PMID: 18261569 DOI: http://dx.doi.org/10.1016/j.transproceed.2007.12.016 http://dx.doi.org/10.1016/j.transproceed...	RCT doadores vivos	Imunossupressão ^# # Ciclosporina + micofenolato de mofetil ou azatioprina e prednisona; vs. Imunossupressão ^# # Ciclosporina + micofenolato de mofetil ou azatioprina e prednisona; + Imunoglobulina antitimócito	37	12 (32,4%)	NR	NR	NR	NR	0 (0%)
									1 (3,22%)
			31	4 (12,9%)
				p = 0,05
Farney et al. 2008⁵5 Farney A, Sundberg A, Moore P, Hartmann E, Rogers J, Doares W, et al. A randomized trial of alemtuzumab vs. anti-thymocyte globulin induction in renal and pancreas transplantation. Clin Transplant 2008;22:41-9.	RCT doadores falecidos ou vivos	Imunoglobulina antitimócito vs. Alemtuzumabe	45	9 (20%)	NR	8 (18%)	NR	43 (96%)	NR
								30 (94%)
			32	0 (0%)		5 (16%)		p = NS
				p = 0,007		p = NS
Hernandez et al. 2007¹⁸18 Hernández D, Miquel R, Porrini E, Fernández A, González-Posada JM, Hortal L, et al. Randomized controlled study comparing reduced calcineurin inhibitors exposure versus standard cyclosporine-based immunosuppression. Transplantation 2007;84:706-14. PMID: 17893603 DOI:http://dx.doi.org/10.1097/01.tp.0000282872.17024.b7 http://dx.doi.org/10.1097/01.tp.00002828...	RCT doadores falecidos	Imunoglobulina antitimócito + Ciclosporina + Azatioprina vs. Basiliximabe + Ciclosporina + MMF vs. Basiliximabe + Tacrolimus + MMF	80	12 (15%)	NR	22 (27,5%)	80 (100%)	73 (91%)	NR
							79 (98,7%)	72 (90%)
			80	11 (13,8%)		26 (32,5%)	78 (97,5%)	65 (82%)
			80	13 (16,3%)		32 (40%)

				p = NS
Thomas et al. 2007¹⁶16 Thomas PG, Woodside KJ, Lappin JA, Vaidya S, Rajaraman S, Gugliuzza KK. Alemtuzumab (Campath 1H) induction with tacrolimus monotherapy is safe for high immunological risk renal transplantation. Transplantation 2007;83:1509-12. PMID: 17565326 DOI:http://dx.doi.org/10.1097/01.tp.0000263344.53000.a1 http://dx.doi.org/10.1097/01.tp.00002633...	RCT doadores falecidos	Alemtuzumabe + Tacrolimus vs. Imunoglobulina antitimócito + Tacrolimus + MMF + corticoide	11	2 (18,2%)	NR	NR	11 (100%)	9 (85,7%)	1 (9%)
							7 (87,5%)	7 (87,5%)	2 (25%)

			10	3 (37,5%)				p = NS

Goggins et al. 2003⁶6 Goggins WC, Pascual MA, Powelson JA, Magee C, Tolkoff-Rubin N, Farrell ML, et al. A prospective, randomized, clinical trial of intraoperative versus postoperative Thymoglobulin in adult cadaveric renal transplant recipients. Transplantation 2003;76:798-802. PMID: 14501856 DOI:http://dx.doi.org/10.1097/01.TP.0000081042.67285.91 http://dx.doi.org/10.1097/01.TP.00000810...	RCT doadores falecidos	Imunoglobulina antitimócito IO vs. Imunoglobulina antitimócito PO	27	1 (3,6%)	NR	4 (14,8%)	27 (100%)	27 (100%)	NR
							31 (100%)	31 (100%)
			31	5 (16%)		11 (35,5%)
				p = 0,11		p < 0,05
Lebranchu et al. 2002⁷7 Lebranchu Y, Bridoux F, Büchler M, Le Meur Y, Etienne I, Toupance O, et al. Immunoprophylaxis with basiliximab compared with antithymocyte globulin in renal transplant patients receiving MMF-containing triple therapy. Am J Transplant 2002;2:48-56. DOI: http://dx.doi.org/10.1034/j.1600-6143.2002.020109.x http://dx.doi.org/10.1034/j.1600-6143.20...	RCT doadores falecidos	Basiliximabe + ciclosporina vs. Imunoglobulina antitimócito + ciclosporina	50	4 (8%)	NR	9 (18%)	49 (98%)	47 (94%)	2 (4%)
							50 (100%)	48 (96%)	0

			50	4 (8%)		11 (22%)

Charpentier et al. 2003¹⁴14 Charpentier B, Rostaing L, Berthoux F, Lang P, Civati G, Touraine JL, et al. A three-arm study comparing immediate tacrolimus therapy with antithymocyte globulin induction therapy followed by tacrolimus or cyclosporine A in adult renal transplant recipients. Transplantation 2003;75:844-51. DOI: http://dx.doi.org/10.1097/01.TP.0000056635.59888.EF http://dx.doi.org/10.1097/01.TP.00000566...	RCT doadores falecidos	Tacrolimus vs. Imunoglobulina antitimócito + Tacrolimus vs. Imunoglobulina antitimócito + ciclosporina	185	47 (25,4%)	NR	NR	180 (97%)	172 (93,2%)	10 (5,4%)
				28 (15,1%)			183 (98,4%)	177 (95,2%)	7 (3,76%)
			186	39 (21,2%)			179 (97%)	167 (90,8%)	16 (8,69%)
				p = 0,004					p = 0,23
			184
Thibaudin et al. 1998¹⁵15 Thibaudin D, Alamartine E, de Filippis JP, Diab N, Laurent B, Berthoux F. Advantage of antithymocyte globulin induction in sensitized kidney recipients: a randomized prospective study comparing induction with and without antithymocyte globulin. Nephrol Dial Transplant 1998;13:711-5. PMID:9550651	RCT doadores falecidos ou vivos	Imunossupressão^* * Ciclosporina + azatioprina e esteroides. vs. Imunossupressão ^* * Ciclosporina + azatioprina e esteroides. + Imunoglobulina antitimócito	42	27 (64%)	NR	14 (33%)	NR	32 (76%)	12 (28,5%)
				18 (38%)				42 (89%)	5 (10,63%)
			47	p = 0,02		13 (28%)		p = 0,04
						p = NS
Kyllonen et al. 2007¹²12 Kyllonen LE, Eklund BH, Pesonen EJ, Salmela KT. Single bolus antithymocyte globulin versus basiliximab induction in kidney transplantation with cyclosporine triple immunosuppression: efficacy and safety. Transplantation 2007;84:75-82. PMID: 17627241 DOI:http://dx.doi.org/10.1097/01.tp.0000268084.64888.f3 http://dx.doi.org/10.1097/01.tp.00002680...	RCT doadores falecidos	Imunoglobulina antitimócito vs. Basiliximabe vs. Imunossupressão^* * Ciclosporina + azatioprina e esteroides.	53	6 (11,3%)	NR	3 (5,7%)	53 (100%)	52 (98,1%)	1 (1,88%)
				0 (0%)			58 (100%)	56 (96,6%)	1 (1,72%)
			58	NR		14 (24,1%)	42 (95,4%)	41 (93,2%)	4 (9,09%)
			44		7 (15,9%)
					p < 0,025
Soulillou et al. 1990⁹9 Soulillou JP, Cantarovich D, Le Mauff B, Giral M, Robillard N, Hourmant M, et al. Randomized controlled trial of a monoclonal antibody against the interleukin-2 receptor (33B3.1) as compared with rabbit antithymocyte globulin for prophylaxis against rejection of renal allografts. N Engl J Med 1990;322:1175-82. PMID: 2157982 DOI: http://dx.doi.org/10.1056/NEJM199004263221702 http://dx.doi.org/10.1056/NEJM1990042632...	RCT doadores falecidos	Imunoglobulina antitimócito vs. 33B3.1	50	5 (10%)	15 (30%)	NR	48 (96%)	42 (85%)	8 (16%)
				7 (14,5%)			48 (96%)	42 (85%)	7 (14%)
			50	p = NS	16 (32%)
Shidban et al. 2003¹⁷17 Shidban H, Sabawi M, Puhawan M, Aswad S, Mendez RG, Mendez R. A prospective, randomized, phase IV comparative trial of Thymoglobulin(r) versus Simulect(r) for the prevention of delayed graft function and acute allograft rejection in renal transplant recipients. Am J Transplant 2003;3:352.	RCT doadores falecidos	Imunoglobulina antitimócito vs. Basiliximabe	50	4 (8%)	NR	22 (44%)	NR	NR	NR
				3 (12%)
			25	p = NS		19 (76%)
Tullius et al. 2003⁶⁶66 Tullius SG, Pratschke J, Strobelt V, Kahl A, Reinke P, May G, et al. ATG versus basiliximab induction therapy in renal allograft recipients receiving a dual immunosuppressive regimen: one-year results. Transplant Proc 2003;35:2100-1. DOI: http://dx.doi.org/10.1016/S0041-1345(03)00679-1 http://dx.doi.org/10.1016/S0041-1345(03)...	RCT doadores falecidos	Imunoglobulina antitimócito vs. Basiliximabe				p = 0,01
			62	22 (35%)	NR	NR	62 (100%)	NR	2 (3,22%)
				20 (32%)			58 (93,5%)		6 (9,6%)
			62	p = NS

	Comparação	N	Taxa de reversão da rejeição
Hoitsma et al. 1982³¹31 Hoitsma AJ, Reekers P, Kreeftenberg JG, van Lier HJ, Capel PJ, Koene RA. Treatment of acute rejection of cadaveric renal allografts with rabbit antithymocyte globulin. Transplantation 1982;33:12-6. PMID: 7039017 DOI: http://dx.doi.org/10.1097/00007890-198201000-00003 http://dx.doi.org/10.1097/00007890-19820...	Imunoglobulina antitimócito (4 mg/kg por dia e doses adicionais 2-7 mg/kg)^ Dose ajustada conforme células T (50-150/mm3). vs. Esteroides	20	18 (90%)
		20	15 (75%)
Hilbrands et al.1996³³33 Hilbrands LB, Hoitsma AJ, Koene RA. Methylpredenisolone versus ATG as initial treatment for acute rejections after renal transplantation [abstract of European Dialysis and Transplant Association-European Renal Association (ERA-EDTA)]. Nephrol Dial Transplant 1996;11:1675.	Imunoglobulina antitimócito (200 mg em dias alternados por 10 dias) vs. Metilprednisolona	19	16 (84%)
		17	9 (53%)
Theodorakis et al. 1998³²32 Theodorakis J, Schneeberger H, Illner WD, Stangl M, Zanker B, Land W. Aggressive treatment of the first acute rejection episode using first-line anti-lymphocytic preparation reduces further acute rejection episodes after human kidney transplantation. Transpl Int 1998;11:S86-9. DOI:http://dx.doi.org/10.1111/j.1432-2277.1998.tb01203.x http://dx.doi.org/10.1111/j.1432-2277.19...	Imunoglobulina antitimócito (4 mg/kg por dia por 7 dias) vs. metilprednisolona	25	NR^* * Não houve diferença na severidade da disfunção renal aguda entre os grupos na 1º rejeição aguda. Houve redução na ocorrência de 2a e 3a rejeições favorável a Imunoglobulina antitimócito.
		25
Baldi et al. 2000²²22 Baldi A, Malaise J, Mourad M, Squifflet JP. A prospective randomized study comparing poly-ATG to mono-OKT3 clonal antibodies for the first rejection therapy after kidney transplantation: long-term results. Transplant Proc 2000;32:429-31. PMID: 10715467 DOI: http://dx.doi.org/10.1016/S0041-1345(00)00838-1 http://dx.doi.org/10.1016/S0041-1345(00)...	Imunoglobulina antitimócito (4 mg/kg por dia por 10 dias) vs. OKT3	28	21 (75%)
		28	14 (50%)
			p = 0,05

	Comparação	N	Taxa de reversão da rejeição	Taxa de sobrevida do enxerto (30-90 dias)	Taxa de rejeição recorrente (90 dias)
Gaber et al. 1998/ Tesi et al. 1997/ Schroeder et al. 1999³⁴34 Gaber AO, First MR, Tesi RJ, Gaston RS, Mendez R, Mulloy LL, et al. Results of the double-blind, randomized, multicenter, phase III clinical trial of Thymoglobulin versus Atgam in the treatment of acute graft rejection episodes after renal transplantation. Transplantation 1998;66:29-37. PMID:9679818 DOI: http://dx.doi.org/10.1097/00007890-199807150-00005 http://dx.doi.org/10.1097/00007890-19980...	Imunoglobulina antitimócito 7-14 dias (1,B mg/kg/dia) vs. Atgan	82	72 (88%)	77 (94%)	14 (17%)
		81	61 (76%)	73 (90%)	29 (36%)
			p = 0,027	p = 0,17	p = 0,011
Mariat et al. 1998³⁷37 Mariat C, Alamartine E, Diab N, de Filippis JP, Laurent B, Berthoux F. A randomized prospective study comparing low-dose OKT3 to low-dose ATG for the treatment of acute steroid-resistant rejection episodes in kidney transplant recipients. Transpl Int 1998;11:231-6.	Imunoglobulina antitimócito < 40 kg = 2B mg/dia 40 - 7BKg = B0 mg/dia > 7B kg = 7B mg/dia vs. OKT3	31	97%	1 (3%)	28%
		29	87%	3 (10%)	38%
			p = NS	p = NS	p = NS
Midtvedt et al. 2003³⁸3 Thymoglobuline. São Paulo, 2014. Bula do remédio [Acesso 20 Mar 2015]. Disponível em: http://www.anvisa.gov.br/datavisa/fila_bula/index.asp http://www.anvisa.gov.br/datavisa/fila_b...	Imunoglobulina antitimócito D1 (2 mg/kg) readministrada na dose de 1 mg/kg se necessário vs. 0 KT3	27	20 (74%)	26 (96,2%)	12 (44%)
		28	22 (78,B%)	26 (92,8%)	14 (B0%)
			p = NS	p = NS	p = NS

	N	Tratamento	Leucopenia (aprox. 1 mês)	Citomegalovírus (infecção)	Neoplasias
Ciancio et al. 2010⁶⁴64 Ciancio G, Gaynor JJ, Roth D, Kupin W, Hanson L, Tueros L, et al. Randomized trial of thymoglobulin versus alemtuzumab (with lower dose maintenance immunosuppression) versus daclizumab in living donor renal transplantation. Transplant Proc 2010;42:3503-6. PMID: 21094804 DOI:http://dx.doi.org/10.1016/j.transproceed.2010.08.045 http://dx.doi.org/10.1016/j.transproceed...	13	Imunoglobulina antitimócito	0 (0%)	0 (0%)	0 (0%)
	13	Alemtuzumabe	6 (46,2%)	0 (0%)	1 (7,69%)
	12	Daclizumabe	0 (0%)	0 (0%)	0 (0%)
			(p = 0,0002)
Brennan et al. 1999²¹21 Brennan DC, Flavin K, Lowell JA, Howard TK, Shenoy S, Burgess S, et al. A randomized, double-blinded comparison of Thymoglobulin versus Atgam for induction immunosuppressive therapy in adult renal transplant recipients. Transplantation 1999;67:1011-8. PMID: 10221486 DOI:http://dx.doi.org/10.1097/00007890-199904150-00013 http://dx.doi.org/10.1097/00007890-19990...	48	Imunoglobulina antitimócito	27 (56%)	6 (12,5%)	0 (0%)
	24	Atgam	1 (4%)	8 (33%)	1 (4%)
			p = NS	p = 0,056
Brennan et al. 2006¹³13 Brennan DC, Daller JA, Lake KD, Cibrik D, Del Castillo D; Thymoglobulin Induction Study Group. Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med 2006;355:1967-77. DOI: http://dx.doi.org/10.1056/NEJMoa060068 http://dx.doi.org/10.1056/NEJMoa060068...	141	Imunoglobulina antitimócito	47 (33,3%)	11 (7,8%)	5 (3,5%)
	137	Basiliximabe	20 (14,6%)	24 (17,5%)	1 (0,7%)
			p < 0,001	p = 0,02	p = 0,21
Noel et al. 2009⁸8 Noël C, Abramowicz D, Durand D, Mourad G, Lang P, Kessler M, et al. Daclizumab versus antithymocyte globulin in high-immunological-risk renal transplant recipients. J Am Soc Nephrol 2009;20:1385-92. DOI: http://dx.doi.org/10.1681/ASN.2008101037 http://dx.doi.org/10.1681/ASN.2008101037...	113	Imunoglobulina antitimócito	9 (7,96%)	21 (18,6%)	1 (0,9%)
	114	Daclizumabe	5 (4,38%)	12 (10,5%)	0 (0%)
			p = 0,36	p = 0,093	p = NS
Mourad et al. 2004²³23 Mourad G, Rostaing L, Legendre C, Garrigue V, Thervet E, Durand D. Sequential protocols using basiliximab versus antithymocyte globulins in renal-transplant patients receiving mycophenolate mofetil and steroids. Transplantation 2004;78:584-90. PMID: 15446319 DOI:http://dx.doi.org/10.1097/01.TP.0000129812.68794.CC http://dx.doi.org/10.1097/01.TP.00001298...	53	Imunoglobulina antitimócito	27 (51%)	22 (41,5%)	NR
	52	Basiliximabe	10 (19,2%)	11 (21,2%)
			p = 0,0007	p = 0,025
Abou-Ayache et al. 2008²⁶26 Abou-Ayache R, Büchler M, Lepogamp P, Westeel PF, Le Meur Y, Etienne I, et al. CMV infections after two doses of daclizumab versus thymoglobulin in renal transplant patients receiving mycophenolate mofetil, steroids and delayed cyclosporine A. Nephrol Dial Transplant 2008;23:2024-32. DOI: http://dx.doi.org/10.1093/ndt/gfm873 http://dx.doi.org/10.1093/ndt/gfm873...	55	Imunoglobulina antitimócito	NR	19 (68%)	0 (0%)
	54	Daclizumabe		18 (83%)	0 (0%)
Ciancio et al. 2005/2008²⁷27 Ciancio G, Burke GW, Gaynor JJ, Carreno MR, Cirocco RE, Mathew JM, et al. A randomized trial of three renal transplant induction antibodies: early comparison of tacrolimus, mycophenolate mofetil, and steroid dosing, and newer immune-monitoring. Transplantation 2005;80:457-65. PMID: 16123718 DOI: http://dx.doi.org/10.1097/01.tp.0000165847.05787.08 http://dx.doi.org/10.1097/01.tp.00001658... ^,⁶⁵65 Ciancio G, Burke GW, Gaynor JJ, Roth D, Kupin W, Rosen A, et al. A randomized trial of thymoglobulin vs. alemtuzumab (with lower dose maintenance immunosuppression) vs. daclizumab in renal transplantation at 24 months of follow-up. Clin Transplant 2008;22:200-10. DOI:http://dx.doi.org/10.1111/j.1399-0012.2007.00774.x http://dx.doi.org/10.1111/j.1399-0012.20...	30	Imunoglobulina antitimócito	NR	1 (3,33%)	0 (0%)
	30	Alemtuzumabe		2 (6,66%)	0 (0%)
	30	Daclizumabe		0 (0%)	1 (3,33%)
Khosroshahi et al. 2008¹¹11 Khosroshahi HT, Tubbs RS, Shoja MM, Ghafari A, Noshad H, Ardalan MR. Effect of prophylaxis with low-dose anti-thymocyte globulin on prevention of acute kidney allograft rejection. Transplant Proc 2008;40:137-9. PMID: 18261569 DOI: http://dx.doi.org/10.1016/j.transproceed.2007.12.016 http://dx.doi.org/10.1016/j.transproceed...	37	Imunossupressão ^# # Ciclosporina + micofenolato de mofetil ou azatioprina e prednisona;	NS	NR	NR
	31	Imunossupressão ^# # Ciclosporina + micofenolato de mofetil ou azatioprina e prednisona; + Imunoglobulina antitimócito
Farney et al. 2008⁵5 Farney A, Sundberg A, Moore P, Hartmann E, Rogers J, Doares W, et al. A randomized trial of alemtuzumab vs. anti-thymocyte globulin induction in renal and pancreas transplantation. Clin Transplant 2008;22:41-9.	45	Imunoglobulina antitimócito	NR	2 (4,44%)	NR
	32	Alemtuzumabe		1 (3,12%)
				p = NS
Hernandez et al. 2007¹⁸18 Hernández D, Miquel R, Porrini E, Fernández A, González-Posada JM, Hortal L, et al. Randomized controlled study comparing reduced calcineurin inhibitors exposure versus standard cyclosporine-based immunosuppression. Transplantation 2007;84:706-14. PMID: 17893603 DOI:http://dx.doi.org/10.1097/01.tp.0000282872.17024.b7 http://dx.doi.org/10.1097/01.tp.00002828...	80	Imunoglobulina antitimócito + Ciclosporina + Azatioprina	NR	33 (41%)	3 (3,75%)
	80	Basiliximabe + Ciclosporina + MMF		16 (20%)	2 (2,5%)
	80	Basiliximabe + Tacrolimus + MMF		20 (25%)	2 (2,5%)
				p = 0,008
Thomas et al. 2007¹⁶16 Thomas PG, Woodside KJ, Lappin JA, Vaidya S, Rajaraman S, Gugliuzza KK. Alemtuzumab (Campath 1H) induction with tacrolimus monotherapy is safe for high immunological risk renal transplantation. Transplantation 2007;83:1509-12. PMID: 17565326 DOI:http://dx.doi.org/10.1097/01.tp.0000263344.53000.a1 http://dx.doi.org/10.1097/01.tp.00002633...	11	Alemtuzumabe + Tacrolimus	p < 0,05 a favor do Alemtuzumabe	NR	0 (0%)
	10	Imunoglobulina antitimócito + Tacrolimus + MMF + corticoide			0 (0%)
Goggins et al. 2003⁶6 Goggins WC, Pascual MA, Powelson JA, Magee C, Tolkoff-Rubin N, Farrell ML, et al. A prospective, randomized, clinical trial of intraoperative versus postoperative Thymoglobulin in adult cadaveric renal transplant recipients. Transplantation 2003;76:798-802. PMID: 14501856 DOI:http://dx.doi.org/10.1097/01.TP.0000081042.67285.91 http://dx.doi.org/10.1097/01.TP.00000810...	27	Imunoglobulina antitimócito IO	NR	1 (3,7%)	NR
	31	Imunoglobulina antitimócito PO		2 (6,5%)
				p = NS
Lebranchu et al. 2002⁷7 Lebranchu Y, Bridoux F, Büchler M, Le Meur Y, Etienne I, Toupance O, et al. Immunoprophylaxis with basiliximab compared with antithymocyte globulin in renal transplant patients receiving MMF-containing triple therapy. Am J Transplant 2002;2:48-56. DOI: http://dx.doi.org/10.1034/j.1600-6143.2002.020109.x http://dx.doi.org/10.1034/j.1600-6143.20...	50	Basiliximabe + ciclosporina	0 (0%)	6 (12%)	0 (0%)
	50	Imunoglobulina antitimócito + ciclosporina	5 (10%)	19 (38%)	0 (0%)
			p < 0,03	p = 0,005
Charpentier et al. 2003¹⁴14 Charpentier B, Rostaing L, Berthoux F, Lang P, Civati G, Touraine JL, et al. A three-arm study comparing immediate tacrolimus therapy with antithymocyte globulin induction therapy followed by tacrolimus or cyclosporine A in adult renal transplant recipients. Transplantation 2003;75:844-51. DOI: http://dx.doi.org/10.1097/01.TP.0000056635.59888.EF http://dx.doi.org/10.1097/01.TP.00000566...	185	Tacrolimus	16 (8,6%)	29 (15,7%)	1 (0,54%)
	186	Imunoglobulina antitimócito +	72 (38,7%)	45 (24,2%)	2 (1,07%)
	184	Tacrolimus	64 (34,8%)	52 (28,3%)	4 (2,17%)
		Imunoglobulina antitimócito + ciclosporina	p < 0,001	p = 0,012
Thibaudin et al. 1998¹⁵15 Thibaudin D, Alamartine E, de Filippis JP, Diab N, Laurent B, Berthoux F. Advantage of antithymocyte globulin induction in sensitized kidney recipients: a randomized prospective study comparing induction with and without antithymocyte globulin. Nephrol Dial Transplant 1998;13:711-5. PMID:9550651	42	Imunossupressão^* * Ciclosporina + azatioprina e esteroides.	7 (17%)	17 (40%)	NR
	47	Imunossupressão ^* * Ciclosporina + azatioprina e esteroides. + Imunoglobulina antitimócito	20 (43%)	28 (59%)
			p = 0,007	p = NS
Kyllonen et al. 2007¹²12 Kyllonen LE, Eklund BH, Pesonen EJ, Salmela KT. Single bolus antithymocyte globulin versus basiliximab induction in kidney transplantation with cyclosporine triple immunosuppression: efficacy and safety. Transplantation 2007;84:75-82. PMID: 17627241 DOI:http://dx.doi.org/10.1097/01.tp.0000268084.64888.f3 http://dx.doi.org/10.1097/01.tp.00002680...	53	Imunoglobulina antitimócito vs. Basiliximabe vs. Imunossupressão^* * Ciclosporina + azatioprina e esteroides.	NR	9 (17%)	2 (3,77%)
	58			9 (16%)	0 (0%)
	44			5 (11%)	1 (2,27%)
				p = NS	p = NS
Soulillou et al. 1990⁹9 Soulillou JP, Cantarovich D, Le Mauff B, Giral M, Robillard N, Hourmant M, et al. Randomized controlled trial of a monoclonal antibody against the interleukin-2 receptor (33B3.1) as compared with rabbit antithymocyte globulin for prophylaxis against rejection of renal allografts. N Engl J Med 1990;322:1175-82. PMID: 2157982 DOI: http://dx.doi.org/10.1056/NEJM199004263221702 http://dx.doi.org/10.1056/NEJM1990042632...	50	Imunoglobulina antitimócito vs. 33B3.1	> no braço de Imunoglobulina antitimócito	9 (18%)	NR
	50		p < 0,005	10 (20%)
Theodorakis et al. 1998³²32 Theodorakis J, Schneeberger H, Illner WD, Stangl M, Zanker B, Land W. Aggressive treatment of the first acute rejection episode using first-line anti-lymphocytic preparation reduces further acute rejection episodes after human kidney transplantation. Transpl Int 1998;11:S86-9. DOI:http://dx.doi.org/10.1111/j.1432-2277.1998.tb01203.x http://dx.doi.org/10.1111/j.1432-2277.19...	25 25	Imunoglobulina antitimócito vs. metilprednisolone	NR	NS	NR
Baldi et al. 2000²²22 Baldi A, Malaise J, Mourad M, Squifflet JP. A prospective randomized study comparing poly-ATG to mono-OKT3 clonal antibodies for the first rejection therapy after kidney transplantation: long-term results. Transplant Proc 2000;32:429-31. PMID: 10715467 DOI: http://dx.doi.org/10.1016/S0041-1345(00)00838-1 http://dx.doi.org/10.1016/S0041-1345(00)...	28	Imunoglobulina antitimócito vs. OKT3	4 (14,2%)	2 (7,1%)	2 (7,14%)
	28		3 (10,7%)	3 (10,7%)	0 (0%)
			p = NS	p = NS
Mariat et al. 1998³⁷37 Mariat C, Alamartine E, Diab N, de Filippis JP, Laurent B, Berthoux F. A randomized prospective study comparing low-dose OKT3 to low-dose ATG for the treatment of acute steroid-resistant rejection episodes in kidney transplant recipients. Transpl Int 1998;11:231-6.	31	Imunoglobulina antitimócito vs. OKT3	NR	12 (39%)	0 (0%)
	29			13 (45%)	2 (7%)
Midtvedt et al. 2003³⁸38 Midtvedt K, Fauchald P, Lien B, Hartmann A, Albrechtsen D, Bjerkely BL, et al. Individualized T cell monitored administration of ATG versus OKT3 in steroid-resistant kidney graft rejection. Clin Transplant 2003;17:69-74. DOI: http://dx.doi.org/10.1034/j.1399-0012.2003.02105.x http://dx.doi.org/10.1034/j.1399-0012.20...	27	Imunoglobulina antitimócito vs. OKT3	NR	14 (51,8%)	NR
	28			11 (39,2%)
				p = NS
Hoitsma et al. 1982³¹31 Hoitsma AJ, Reekers P, Kreeftenberg JG, van Lier HJ, Capel PJ, Koene RA. Treatment of acute rejection of cadaveric renal allografts with rabbit antithymocyte globulin. Transplantation 1982;33:12-6. PMID: 7039017 DOI: http://dx.doi.org/10.1097/00007890-198201000-00003 http://dx.doi.org/10.1097/00007890-19820...	20	Imunoglobulina antitimócito vs. esteroides	NR	NS	NR
	20
Tullius et al. 2003⁶⁶66 Tullius SG, Pratschke J, Strobelt V, Kahl A, Reinke P, May G, et al. ATG versus basiliximab induction therapy in renal allograft recipients receiving a dual immunosuppressive regimen: one-year results. Transplant Proc 2003;35:2100-1. DOI: http://dx.doi.org/10.1016/S0041-1345(03)00679-1 http://dx.doi.org/10.1016/S0041-1345(03)...	62	Imunoglobulina antitimócito vs. Basiliximabe	NR	7 (11,3%)	NR
	62			2 (3,22%)
				p = NS

	Acesso de administração	Dias de aplicação	Momento da 13 aplicação de Imunoglobulina antitimócito	Dose mg/kg/dia (dose total de Imunoglobulina antitimócito)
Ciancio et al. 2010⁶⁴64 Ciancio G, Gaynor JJ, Roth D, Kupin W, Hanson L, Tueros L, et al. Randomized trial of thymoglobulin versus alemtuzumab (with lower dose maintenance immunosuppression) versus daclizumab in living donor renal transplantation. Transplant Proc 2010;42:3503-6. PMID: 21094804 DOI:http://dx.doi.org/10.1016/j.transproceed.2010.08.045 http://dx.doi.org/10.1016/j.transproceed...	NR	D0 a D7	pós-operatório	1 mg/kg/dia (7 dsses)
Brennan et al. 1999²¹21 Brennan DC, Flavin K, Lowell JA, Howard TK, Shenoy S, Burgess S, et al. A randomized, double-blinded comparison of Thymoglobulin versus Atgam for induction immunosuppressive therapy in adult renal transplant recipients. Transplantation 1999;67:1011-8. PMID: 10221486 DOI:http://dx.doi.org/10.1097/00007890-199904150-00013 http://dx.doi.org/10.1097/00007890-19990...	NR	D0 a D6	intraoperatório (antes da reperfusão ds enxerts)	1,B mg/kg/dia (6 dsses)
Brennan et al. 2006¹³13 Brennan DC, Daller JA, Lake KD, Cibrik D, Del Castillo D; Thymoglobulin Induction Study Group. Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med 2006;355:1967-77. DOI: http://dx.doi.org/10.1056/NEJMoa060068 http://dx.doi.org/10.1056/NEJMoa060068...	NR	D0 a D4	intraoperatório (antes da reperfusão ds enxerts)	1,B mg/kg/dia (7,Bmg/kg)
Noël et al. 2009⁸8 Noël C, Abramowicz D, Durand D, Mourad G, Lang P, Kessler M, et al. Daclizumab versus antithymocyte globulin in high-immunological-risk renal transplant recipients. J Am Soc Nephrol 2009;20:1385-92. DOI: http://dx.doi.org/10.1681/ASN.2008101037 http://dx.doi.org/10.1681/ASN.2008101037...	cateter central	D0 a D7	intraoperatório (antes da reperfusão ds enxerts)	1,2B mg/kg/dia
Mourad et al. 2004²³23 Mourad G, Rostaing L, Legendre C, Garrigue V, Thervet E, Durand D. Sequential protocols using basiliximab versus antithymocyte globulins in renal-transplant patients receiving mycophenolate mofetil and steroids. Transplantation 2004;78:584-90. PMID: 15446319 DOI:http://dx.doi.org/10.1097/01.TP.0000129812.68794.CC http://dx.doi.org/10.1097/01.TP.00001298...	NR	NR	NR	1 mg/kg/dia D0 e D1 e ajustada conforme CD3+ (média de B,4 infusões)
Abou-Ayache et al. 2008²⁶26 Abou-Ayache R, Büchler M, Lepogamp P, Westeel PF, Le Meur Y, Etienne I, et al. CMV infections after two doses of daclizumab versus thymoglobulin in renal transplant patients receiving mycophenolate mofetil, steroids and delayed cyclosporine A. Nephrol Dial Transplant 2008;23:2024-32. DOI: http://dx.doi.org/10.1093/ndt/gfm873 http://dx.doi.org/10.1093/ndt/gfm873...	NR	D0 a D9	pós-speratória	1-1,Bmg/kg/dia (< 9 dsses, média de 6,B dias)
Ciancio et al. 2005/2008²⁷27 Ciancio G, Burke GW, Gaynor JJ, Carreno MR, Cirocco RE, Mathew JM, et al. A randomized trial of three renal transplant induction antibodies: early comparison of tacrolimus, mycophenolate mofetil, and steroid dosing, and newer immune-monitoring. Transplantation 2005;80:457-65. PMID: 16123718 DOI: http://dx.doi.org/10.1097/01.tp.0000165847.05787.08 http://dx.doi.org/10.1097/01.tp.00001658... ^,⁶⁴64 Ciancio G, Gaynor JJ, Roth D, Kupin W, Hanson L, Tueros L, et al. Randomized trial of thymoglobulin versus alemtuzumab (with lower dose maintenance immunosuppression) versus daclizumab in living donor renal transplantation. Transplant Proc 2010;42:3503-6. PMID: 21094804 DOI:http://dx.doi.org/10.1016/j.transproceed.2010.08.045 http://dx.doi.org/10.1016/j.transproceed...	NR	7 dias	pós-speratória	1 mg/kg/dia (x 7 dsses)
Khosroshahi et al. 2008¹¹11 Khosroshahi HT, Tubbs RS, Shoja MM, Ghafari A, Noshad H, Ardalan MR. Effect of prophylaxis with low-dose anti-thymocyte globulin on prevention of acute kidney allograft rejection. Transplant Proc 2008;40:137-9. PMID: 18261569 DOI: http://dx.doi.org/10.1016/j.transproceed.2007.12.016 http://dx.doi.org/10.1016/j.transproceed...	NR	D0	pré-speratória (12h antes da cirurgia)	4-B mg/kg
Farney et al. 2008⁵5 Farney A, Sundberg A, Moore P, Hartmann E, Rogers J, Doares W, et al. A randomized trial of alemtuzumab vs. anti-thymocyte globulin induction in renal and pancreas transplantation. Clin Transplant 2008;22:41-9.	cateter central	D0, D2, D4, D6, etc.	intraoperatória	1,B mg/kg/dia (< 7 dsses + B mg/kg)
Hernandez et al. 2007¹⁸18 Hernández D, Miquel R, Porrini E, Fernández A, González-Posada JM, Hortal L, et al. Randomized controlled study comparing reduced calcineurin inhibitors exposure versus standard cyclosporine-based immunosuppression. Transplantation 2007;84:706-14. PMID: 17893603 DOI:http://dx.doi.org/10.1097/01.tp.0000282872.17024.b7 http://dx.doi.org/10.1097/01.tp.00002828...	NR	7 dias	NR	1-1,B mg/kg/dia (7 dias)
Thomas et al. 2007¹⁶16 Thomas PG, Woodside KJ, Lappin JA, Vaidya S, Rajaraman S, Gugliuzza KK. Alemtuzumab (Campath 1H) induction with tacrolimus monotherapy is safe for high immunological risk renal transplantation. Transplantation 2007;83:1509-12. PMID: 17565326 DOI:http://dx.doi.org/10.1097/01.tp.0000263344.53000.a1 http://dx.doi.org/10.1097/01.tp.00002633...	NR	D0 a D4	pré-operatória	1,B mg/kg/dia (x4)
Goggins et al. 2003⁶6 Goggins WC, Pascual MA, Powelson JA, Magee C, Tolkoff-Rubin N, Farrell ML, et al. A prospective, randomized, clinical trial of intraoperative versus postoperative Thymoglobulin in adult cadaveric renal transplant recipients. Transplantation 2003;76:798-802. PMID: 14501856 DOI:http://dx.doi.org/10.1097/01.TP.0000081042.67285.91 http://dx.doi.org/10.1097/01.TP.00000810...	maioria por cateter periférico	D0 a D6	intraoperatório ou no pós-operatório	1 mg/kg (< 6 dsses)
Lebranchu et al. 2002⁷7 Lebranchu Y, Bridoux F, Büchler M, Le Meur Y, Etienne I, Toupance O, et al. Immunoprophylaxis with basiliximab compared with antithymocyte globulin in renal transplant patients receiving MMF-containing triple therapy. Am J Transplant 2002;2:48-56. DOI: http://dx.doi.org/10.1034/j.1600-6143.2002.020109.x http://dx.doi.org/10.1034/j.1600-6143.20...	Fístula AV ou cateter central	D1 a D1G	pós-operatória (24 horas após transplante)	1-1,B mg/kg/dia (media de 6-1G dias e máxims de 10 dias)
Charpentier et al. 2003¹⁴14 Charpentier B, Rostaing L, Berthoux F, Lang P, Civati G, Touraine JL, et al. A three-arm study comparing immediate tacrolimus therapy with antithymocyte globulin induction therapy followed by tacrolimus or cyclosporine A in adult renal transplant recipients. Transplantation 2003;75:844-51. DOI: http://dx.doi.org/10.1097/01.TP.0000056635.59888.EF http://dx.doi.org/10.1097/01.TP.00000566...	NR	D1 a D1G	pós-operatória (< 12 horas após transplante)	1,2B mg/kg e ajustada conforme condições clínicas
Thibaudin et al. 1998¹⁵15 Thibaudin D, Alamartine E, de Filippis JP, Diab N, Laurent B, Berthoux F. Advantage of antithymocyte globulin induction in sensitized kidney recipients: a randomized prospective study comparing induction with and without antithymocyte globulin. Nephrol Dial Transplant 1998;13:711-5. PMID:9550651	NR	D0 a D1G	intraoperatória (antes da reperfusão ds enxerts)	1,2B mg/kg/dia D0 e ajustada conforme CD 2+ e CD3+
Kyllsnen et al. 2007¹²12 Kyllonen LE, Eklund BH, Pesonen EJ, Salmela KT. Single bolus antithymocyte globulin versus basiliximab induction in kidney transplantation with cyclosporine triple immunosuppression: efficacy and safety. Transplantation 2007;84:75-82. PMID: 17627241 DOI:http://dx.doi.org/10.1097/01.tp.0000268084.64888.f3 http://dx.doi.org/10.1097/01.tp.00002680...	NR	D0	intraoperatória (antes da reperfusão ds enxerts)	9 mg/kg dose única
Soulillou et al. 1990⁹9 Soulillou JP, Cantarovich D, Le Mauff B, Giral M, Robillard N, Hourmant M, et al. Randomized controlled trial of a monoclonal antibody against the interleukin-2 receptor (33B3.1) as compared with rabbit antithymocyte globulin for prophylaxis against rejection of renal allografts. N Engl J Med 1990;322:1175-82. PMID: 2157982 DOI: http://dx.doi.org/10.1056/NEJM199004263221702 http://dx.doi.org/10.1056/NEJM1990042632...	Fístula AV ou cateter central	D0 a D14	pós-operatória	1,B mg/kg/dia (máxims de 2,B mg/kg)
Shidban et al. 2003¹⁷17 Shidban H, Sabawi M, Puhawan M, Aswad S, Mendez RG, Mendez R. A prospective, randomized, phase IV comparative trial of Thymoglobulin(r) versus Simulect(r) for the prevention of delayed graft function and acute allograft rejection in renal transplant recipients. Am J Transplant 2003;3:352.	NR	D0 a DB	NR	1,B mg/kg/dia psr B dias não ultrapassando 100 mg/dia);
Tullius et al. 2003⁶⁶66 Tullius SG, Pratschke J, Strobelt V, Kahl A, Reinke P, May G, et al. ATG versus basiliximab induction therapy in renal allograft recipients receiving a dual immunosuppressive regimen: one-year results. Transplant Proc 2003;35:2100-1. DOI: http://dx.doi.org/10.1016/S0041-1345(03)00679-1 http://dx.doi.org/10.1016/S0041-1345(03)...	NR	NR	NR	9 mg/kg perioperatório

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Guia prático para usar Thymoglobuline® (globulina antitimócito) em transplante renal

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Guia prático para usar Thymoglobuline^® (globulina antitimócito) em transplante renal