Article ; Online: Acute Rejection Rates and Graft Outcomes According to Induction Regimen among Recipients of Kidneys from Deceased Donors Treated with Tacrolimus and Mycophenolate.
Clinical journal of the American Society of Nephrology : CJASN
2016 Volume 11, Issue 9, Page(s) 1650–1661
Abstract: ... antithymocyte globulin (r-ATG), alemtuzumab, and no induction. The main outcomes were incidence of acute rejection ... respectively. Acute rejection within the first year and overall graft failure within 5 years of transplantation ... 627) to compare outcomes of IL2-RA and other induction agents. We initially divided the cohort ...
| Abstract | Background and objectives: IL-2 receptor antagonist (IL2-RA) is recommended as a first-line agent for induction therapy in renal transplantation. However, this remains controversial in deceased donor renal transplantation (DDRT) maintained on tacrolimus (TAC)/mycophenolic acid (MPA) with or without steroids. Design, setting, participants, & measurements: We studied the United Network for Organ Sharing Registry for patients receiving DDRT from 2000 to 2012 maintained on TAC/MPA at transplantation hospital discharge (n=74,627) to compare outcomes of IL2-RA and other induction agents. We initially divided the cohort into two groups on the basis of steroid use at the time of discharge: steroid (n=59,010) versus no steroid (n=15,617). Each group was stratified into induction categories: IL2-RA, rabbit antithymocyte globulin (r-ATG), alemtuzumab, and no induction. The main outcomes were incidence of acute rejection within the first year and overall graft failure (defined as graft failure and/or death) post-transplantation. Propensity score (PS), specifically inverse probability of treatment weight, analysis was used to minimize selection bias caused by nonrandom assignment of induction therapies. Results: Median (25th, 75th percentiles) follow-up times were 3.9 (1.1, 5.9) and 3.2 (1.1, 4.9) years for steroid and no steroid groups, respectively. Acute rejection within the first year and overall graft failure within 5 years of transplantation were more common in the no induction category (13.3%; P<0.001 and 28%; P=0.01, respectively) in the steroid group and the IL2-RA category (11.1%; P=0.16 and 27.4%; P<0.001, respectively) in the no steroid group. Compared with IL2-RA, PS-weighted and covariate-adjusted multivariable logistic and Cox analyses showed that outcomes in the steroid group were similar among induction categories, except that acute rejection was significantly lower with r-ATG (odds ratio [OR], 0.68; 95% confidence interval [95% CI], 0.62 to 0.74). In the no steroid group, compared with IL2-RA, odds of acute rejection with r-ATG (OR, 0.80; 95% CI, 0.60 to 1.00) and alemtuzumab (OR, 0.68; 95% CI, 0.53 to 0.88) were lower, and r-ATG was associated with better graft survival (hazard ratio, 0.86; 95% CI, 0.75 to 0.99). Conclusions: In DDRT, compared with IL2-RA induction, no induction was associated with similar outcomes when TAC/MPA/steroids were used. r-ATG seems to offer better graft survival over IL2-RA in steroid avoidance protocols. |
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| MeSH term(s) | Adolescent ; Adult ; Aged ; Alemtuzumab/therapeutic use ; Antilymphocyte Serum/therapeutic use ; Female ; Follow-Up Studies ; Graft Rejection/epidemiology ; Graft Rejection/prevention & control ; Graft Survival ; Humans ; Immunosuppressive Agents/therapeutic use ; Incidence ; Induction Chemotherapy/methods ; Kidney Transplantation/methods ; Maintenance Chemotherapy/methods ; Male ; Middle Aged ; Mycophenolic Acid/therapeutic use ; Propensity Score ; Receptors, Interleukin-2/antagonists & inhibitors ; Registries ; Steroids/therapeutic use ; Tacrolimus/therapeutic use ; Young Adult | |||||
| Chemical Substances | Antilymphocyte Serum ; Immunosuppressive Agents ; Receptors, Interleukin-2 ; Steroids ; Alemtuzumab (3A189DH42V) ; Mycophenolic Acid (HU9DX48N0T) ; Tacrolimus (WM0HAQ4WNM) | |||||
| Language | English | |||||
| Publishing date | 2016-06-30 | |||||
| Publishing country | United States | |||||
| Document type | Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S. ; Research Support, N.I.H., Extramural | |||||
| ZDB-ID | 2226665-3 | |||||
| ISSN | 1555-905X ; 1555-9041 | |||||
| ISSN (online) | 1555-905X | |||||
| ISSN | 1555-9041 | |||||
| DOI | 10.2215/CJN.13171215 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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