Clinical Correlates and Outcomes of Dual Basiliximab and Antithymocyte Globulin Induction in Kidney Transplant Recipients: A National Study. Issue 8 (23rd July 2021)

• Record Type: Journal Article
• Authors: Lam, Ngan N.; Jeong, Rachel; Quinn, Robert R.; Ravani, Pietro; Xiao, Huiling; McAdams-DeMarco, Mara; Axelrod, David A.; Schnitzler, Mark A.; Snyder, Jon J.; Lentine, Krista L.
• Is Part Of: Transplantation direct. Volume 7:Issue 8(2021)
• Page Start: e736
• Publication Date: 2021-07-23
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation -- Periodicals; 362.19795
• DOI: 10.1097/TXD.0000000000001190
• Languages: English
• ISSNs: 2373-8731

Abstract

Abstract : Supplemental Digital Content is available in the text. Abstract : Background: The unplanned use of dual induction therapy with interleukin-2 receptor-blocking antibodies (IL2rAb) and antithymocyte globulin (ATG) may portend adverse outcomes. Methods: We used national transplant registry data to study clinical correlates and outcomes of single versus dual induction therapy in adult kidney-only transplant recipients in the United States (2005–2018). The risk of death and graft loss at 1 and 5 y, according to induction therapy type, was assessed using multivariate Cox regression analysis (adjusted hazard ratio with 95% upper and lower confidence limits [LCL aHRUCL ]). Results: Of the 157 351 recipients included in the study, 67% were treated with ATG alone, 29% were treated with IL2rAb alone, and 5% were treated with both. Compared with IL2rAb alone, the strongest correlates of dual induction included Black race, calculated panel reactive antibody ≥80%, prednisone-sparing maintenance immunosuppression, more recent transplant eras, longer cold ischemia time, and delayed graft function. Compared with ATG alone, dual induction was associated with an increased 5-y risk of death (aHR 1.07 1.151.23 ; P < 0.0001), death-censored graft failure (aHR 1.05 1.131.22 ; P < 0.05), and all-cause graft failure (aHR 1.06 1.121.18 ; P < 0.0001). Conclusions: Further research is needed to develop risk-prediction tools to further inform optimal, individualized induction protocols for kidney transplant recipients.