Table 2: Randomized clinical trials of rATG versus IL-2RA induction in adult kidney transplant recipients. Induction and maintenance therapies were started after procedure on the day of transplantation unless otherwise stated.

StudyPopulationnrATG regimenIL-2RA regimenDGF (rATG vs IL-2RA)BPAR (rATG vs IL-2RA)Other findings (rATG vs IL-2RA)

Thomusch et al., 2016 [65]Low immunological risk (including no pretransplant DSA, PRA ≤30%)rATG (1.5 mg/kg intraoperatively, 1.5 mg/kg x 3 to day 3) 
Immediate low-
dose TAC 
MMF 
Steroids to day 8
Basiliximab (20 mg/kg intraoperatively, 20 mg day 4)  
Immediate low-
dose TAC 
MMF 
Steroids to day 8
Not stated9.9% vs 10.6% (p=0.87)-

Pilch et al., 2014 [66]Unselected (other than ABO compatible)200rATG (5 x 1.5 mg/kg) 
Immediate TAC 
MMF 
Steroids
Daclizumab (2 x 1 mg/kg)
Immediate TAC 
MMF 
Steroids
9% vs 10% 
(p=0.81)
Month 6:  
2% versus 8% (p=0.05)
Mean time to BPAR by month 12: 98 vs 241 days (p<0.001)

Noël et al., 2009 [50]High immunological risk (including PRA ≥30% or peak PRA ≥50%), no positive T-cell cross-match or DCD227rATG (1.25 mg intraoperatively and on days 1- 7) 
TAC from day 2-5 
MMF 
Steroids
Daclizumab (5 x 1 mg/kg)  
Immediate TAC 
MMF 
Steroids
31.5% vs 44.6% (p=0.044)Month 12: 
15.5% vs 27.2% (p=0.016)
Steroid-resistant BPAR at month 12: 2.7% vs 14.9% (p=0.002)

Abou-Ayache et al., 2008 [54]Low or moderate immunological risk (including CIT ≤36 hours, PRA ≤20%), deceased donor113rATG (dose adjusted based on CD2/CD3 count) 
CsA started by day 7 (or earlier depending on graft function) 
MMF 
Steroids
Daclizumab (2 mg/kg pretransplant, 1 mg/kg on day 14) 
CsA started by day 7 (or earlier depending on graft function) 
MMF 
Steroids
12.7% vs 18.5%Month 12 
14.5% vs 16.7% (n.s.)
Mean time to BPAR by month 12: 82 vs 133 days (n.s.)

Brennan et al., 2006 [49]High risk for acute rejection or BPAR278rATG (1.5 mg/kg intraoperatively, then 1.5 mg/kg x 4) 
CsA started by day 4 (or earlier depending on graft function)  
MMF 
Steroids
Basiliximab (2 x 20 mg)  
CsA started by day 4 (or earlier depending on graft function) 
MMF 
Steroids
40.4% vs 44.5% (p=0.54)Month 12: 15.6% vs 25.5% (p=0.02)Steroid-resistant BPAR at month 12: 1.4% vs 8.0% (p=0.005)

Mourad et al., 2004 [52]Low or moderate immunological risk (including PRA ≤20%), deceased donor105rATG (1 mg/kg on days 0 and 1, then based on CD3 count)  
CsA according to renal function 
MMF 
Steroids
Basiliximab (2 x 20mg)  
CsA according to renal function 
MMF 
Steroids
30.2% vs 28.8%Month 12: 9.4% vs 9.6% (n.s.)Significantly more
frequent CMV infections, leukopenia and thrombocytopenia
with rATG vs basiliximab

Lebranchu et al., 2002 [51]Low or moderate immunological risk (including CIT ≤36 hours, PRA ≤25%, no T-cell cross-match)100rATG (dose adjusted based on CD2/CD3 count) 
CsA (started based on graft function)  
MMF 
Steroids
Basiliximab (2 x 20mg)  
Immediate CsA 
MMF 
Steroids
6% vs 14%Month 12: 8.0% vs 8.5% (n.s.)Significantly more frequent CMV infections with rATG vs basiliximab

third treatment group comprised basiliximab with low-dose TAC, MMF, and steroid maintenance therapy (data not shown).
p value provided.
to basiliximab (2 x 20 mg) after withdrawal of daclizumab from the market.
on duration of cold ischemia time and predefined donor/recipient risk factors.
BPAR, biopsy-proven acute rejection; CIT, cold ischemia time; CMV, cytomegalovirus; CsA, cyclosporine; DCD, donation after circulatory death; DGF, delayed graft function; DSA, donor-specific antibodies; IL-2RA, interleukin-2 receptor antagonist; MMF, mycophenolate mofetil; n.s., not significant; PRA, panel reactive antibodies; rATG, rabbit antithymocyte globulin; TAC, tacrolimus.