The impact of induction therapy in low-immunological risk kidney transplant recipients regardless of HLA matching

• Published in: Transplant immunology Vol. 76; p. 101773
• Main Authors: Abou-Jaoudé, Maroun, Akiki, Dany, Moussawi, Ali, Abou-Jaoudé, Walid
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2023
• Subjects: Antibodies; Graft Rejection; Graft Survival; HLA Antigens; HLA matching; Humans; Immunosuppressive Agents - adverse effects; Induction Chemotherapy; Induction therapy; Kidney transplantation; Kidney Transplantation - adverse effects; Low-immunological risk; Retrospective Studies; Retrospective study; Transplant Recipients; ESRD; HLA matching; PS; Retrospective study; N; GFR; DSA; IL2-RA; ATG-F; EBV; UNOS; BMI; GF; DGF; Low-immunological risk; CyA-me; MMF; KT; KTRs; CNIs; HSV; GS; CMV; AR; ATG; Induction therapy; rATG; KDIGO; HLA; OPTN; PCR; PRA; Tacro; Kidney transplantation; MPA
• ISSN: 0966-3274; 1878-5492
• DOI: 10.1016/j.trim.2022.101773

Induction agents have proved to reduce the rate of acute rejection (AR) in kidney transplant recipients (KTRs) without improving long-term graft and patient survival (PS). This study evaluates the utility of induction therapy in low immunological risk KTRs regardless of donor-to-recipient HLA matching. We retrospectively reviewed the records of 218 patients undergoing kidney transplantation (KT). These patients were divided into two groups according to the usage of induction therapy: 82 did not receive any induction therapy (Group I), and 136 patients received either Anti-IL2 receptor antibodies or anti-thymocyte globulin (Group II). All patients had panel reactive antibody (PRA) < 20% and absence of donor-specific antibodies (DSA). The difference in outcomes were assessed at different intervals following KT. The rate of bacterial infections at one year (p-value = 0.032) and the frequency of CMV disease (p-value = 0.044) were significantly higher in Group II (with induction therapy). The duration of hospital stay, the rate and severity of acute rejection, the occurrence of delayed graft function, the rate and type of surgical complications at one year, and the graft function and survival at one and three years were similar between the two groups (p-value = NS). In addition, the financial burden is much less in Group I (without induction therapy), reducing the total cost of the transplant procedure. We conclude that induction therapy in low-immunological risk kidney transplant patients is not a must regardless of donor-to-recipient HLA matching. Therefore, induction therapy did not yield significant health results, but had negative financial consequences. •Induction therapy is no more considered a major constituent of KT in low-immunological risk KTRs regardless of HLA-matching.•Induction therapy with IL2-RA or ATG-F didn't improve KT by 3 years at the levels of AR, hospital stay, DGF, GF, GS and PS.•Induction therapy has increased the hospital bill by 11 to 20% and the infection rate in KTRs, especially by CMV.•Low-immunological risk KTRs were divided into induction therapy and no-induction therapy groups regardless of HLA matching.