Effect of Induction Agent on Posttransplant Outcomes in Deceased Donor Kidney Transplant Recipients: Influence of Race

• Published in: Transplantation proceedings Vol. 45; no. 1; pp. 119 - 121
• Main Authors: Hussain, S.M, Sureshkumar, K.K, Ko, T.Y, Marcus, R.J
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2013
• Subjects: Adult; African Americans; Alemtuzumab; Antibodies, Monoclonal, Humanized - therapeutic use; Antilymphocyte Serum - therapeutic use; Calcineurin Inhibitors; Female; Follow-Up Studies; Graft Survival; Humans; Immunosuppressive Agents - therapeutic use; Kidney Failure, Chronic - ethnology; Kidney Failure, Chronic - therapy; Kidney Transplantation - methods; Male; Middle Aged; Multivariate Analysis; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Postoperative Complications; Receptors, Interleukin-2 - antagonists & inhibitors; Steroids - chemistry; Surgery; Time Factors; Tissue Donors; Young Adult
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2012.06.066

Abstract Background The effect of induction agents on kidney transplant outcomes with respect to race is not well studied. We aimed to compare the outcomes of deceased donor kidney (DDK) transplants in African American (AA) and non-African American (non-AA) recipients who underwent induction therapy with rabbit-antithymoglobulin (rATG), alemtuzumab (ALE), or interleukin (IL)-2 receptor blocker (IL-2B) and were maintained on a calcineurin inhibitor, (CNI)/mycophenolate mofetil (MMF)–based regimen with/without steroid. Methods Using OPTN/UNOS database, we identified patients (≥18 years) who underwent DDK transplants from January 2000 to December 2008 and received rATG ( n = 21,506), ALE ( n = 3476), or IL- 2B ( n = 17,869) and were maintained on a CNI/MMF–based regimen with/without steroids. Multivariate analysis was performed adjusting for steroid use and factors known to adversely impact graft outcome. Results The median follow up was 29.6 months (range, 10.7–60.1). ALE induction as compared to rATG had inferior adjusted graft ( P < .001) and patient ( P = .003) survivals in non-AA recipients but similar in AA recipients. In non-AA recipients, IL-2 induction as compared with rATG had similar adjusted graft but inferior patient survival ( P = .04), and in AA recipients had inferior graft ( P = .002) but similar patient survival. Conclusion Our study shows racial differences in renal transplant outcomes with regard to induction modality.