TY - JOUR
T1 - Preemptive Second Kidney Transplant Outcomes by Induction Type in the United States
AU - Riad, Samy
AU - Swanson, Kurtis J.
AU - El-Rifai, Rasha
AU - Larrieux, Gregory
AU - Gylten, Logan
AU - Jackson, Scott
AU - Kandaswamy, Raja
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/10
Y1 - 2022/10
N2 - Background: The role of induction in preemptive second kidney recipients is unclear. We examined the association between induction therapy and the long-term graft and recipient survival in the settings of tacrolimus and mycophenolate maintenance. Methods: We identified all preemptive second kidney transplant recipients between 2000 and 2020 in the Scientific Registry of Transplant Recipients. We excluded those with missing or mixed induction regimens and positive crossmatch. We grouped recipients by induction type into 3 groups: anti-thymocyte globulin (n = 1442), alemtuzumab (n = 362), and interleukin-2 receptor antagonist (IL-2RA; n = 481). We generated Kaplan-Meier curves of the recipient and death-censored graft survival (DCGS) with follow-up censored at 10 years. We used multivariable Cox proportional hazards models to examine the association between induction and the above outcomes. We adjusted the models for recipient and donor variables. Results: Rates of delayed graft function, rejection, hospitalization, and post-transplant lymphoproliferative disorder at one year were not statistically different. Recipient survival did not vary by induction type in the Kaplan-Meier analysis (log-rank P =.189) or in the multivariable model. However, DCGS was the lowest in the Alemtuzumab group (log-rank P =.01). In the multivariable models, alemtuzumab was associated with a 57% increased risk of graft loss (1.57, 95% confidence interval (1.08, 2.30), P =.019) compared to anti-thymocyte. Live-donor kidneys were associated with significantly better recipient survival and DCGS. Conclusions: Compared to anti-thymocyte induction, alemtuzumab, but not IL-2RA, was associated with inferior graft survival in preemptive second transplant recipients discharged on tacrolimus and mycophenolate.
AB - Background: The role of induction in preemptive second kidney recipients is unclear. We examined the association between induction therapy and the long-term graft and recipient survival in the settings of tacrolimus and mycophenolate maintenance. Methods: We identified all preemptive second kidney transplant recipients between 2000 and 2020 in the Scientific Registry of Transplant Recipients. We excluded those with missing or mixed induction regimens and positive crossmatch. We grouped recipients by induction type into 3 groups: anti-thymocyte globulin (n = 1442), alemtuzumab (n = 362), and interleukin-2 receptor antagonist (IL-2RA; n = 481). We generated Kaplan-Meier curves of the recipient and death-censored graft survival (DCGS) with follow-up censored at 10 years. We used multivariable Cox proportional hazards models to examine the association between induction and the above outcomes. We adjusted the models for recipient and donor variables. Results: Rates of delayed graft function, rejection, hospitalization, and post-transplant lymphoproliferative disorder at one year were not statistically different. Recipient survival did not vary by induction type in the Kaplan-Meier analysis (log-rank P =.189) or in the multivariable model. However, DCGS was the lowest in the Alemtuzumab group (log-rank P =.01). In the multivariable models, alemtuzumab was associated with a 57% increased risk of graft loss (1.57, 95% confidence interval (1.08, 2.30), P =.019) compared to anti-thymocyte. Live-donor kidneys were associated with significantly better recipient survival and DCGS. Conclusions: Compared to anti-thymocyte induction, alemtuzumab, but not IL-2RA, was associated with inferior graft survival in preemptive second transplant recipients discharged on tacrolimus and mycophenolate.
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U2 - 10.1016/j.transproceed.2022.08.026
DO - 10.1016/j.transproceed.2022.08.026
M3 - Article
C2 - 36210195
AN - SCOPUS:85139734185
SN - 0041-1345
VL - 54
SP - 2125
EP - 2132
JO - Transplantation proceedings
JF - Transplantation proceedings
IS - 8
ER -