6 Scopus citations


It is well recognized that elderly transplant recipients experience lower rates of acute rejection with higher rates of infectious complications compared to their younger counterparts. While less intensive immunosuppression may be preferable, there are no recommendations for depleting versus non-depleting induction strategies. We sought to compare infectious and immunologic outcomes between anti-thymocyte globulin (ATG) and basiliximab (IL2RA) induction in elderly kidney transplant recipients (KTRs). We performed a review of 146 KTRs ≥65 years receiving ATG or IL2RA induction. Per institution protocol, depleting induction was administered to patients with the following characteristics, irrespective of age: African American (AA), PRA ≥20%, and/or re-transplantation. Infectious complications (bacterial, viral, and invasive fungal) and graft outcomes at 1 year were compared. There were significantly more AA, deceased donors, and sensitized KTRs in the ATG group, reflecting the different criteria for induction agent. ATG KTRs experienced higher rates of overall infectious complications (77% vs 56%, p=0.01), owing predominately to increased rates of bacterial (54% vs 39%, p=0.08) and viral infections (51% vs 35%, p=0.05). Urinary tract infections and CMV in particular occurred at high rates among ATG patients (46% and 32%, respectively). In multivariate analysis, the only independent risk factor associated with increased risk for infection was induction with ATG (adjusted HR 1.71 [95% CI 1.04-2.83], p = 0.04). Elderly ATG patients experienced higher rates of acute rejection and dnDSAs, though overall rates of immunologic outcomes were low. Elderly KTRs receiving ATG are at an increased risk for infectious complications, which was largely attributable to high rates of urinary tract infections and CMV. Additional strategies aimed at mitigating these complications in elderly patients requiring ATG may be beneficial.

Original languageEnglish (US)
Pages (from-to)e13257
JournalTransplant Infectious Disease
StateE-pub ahead of print - Feb 7 2020


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