TY - JOUR
T1 - Clinical Correlates and Outcomes of Dual Basiliximab and Antithymocyte Globulin Induction in Kidney Transplant Recipients
T2 - A National Study
AU - Lam, Ngan N.
AU - Jeong, Rachel
AU - Quinn, Robert R.
AU - Ravani, Pietro
AU - Xiao, Huiling
AU - McAdams-Demarco, Mara
AU - Axelrod, David A.
AU - Schnitzler, Mark A.
AU - Snyder, Jon J.
AU - Lentine, Krista L.
N1 - Funding Information:
K.L.L., M.M.D., D.A.A., and M.A.S. received funding from a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01DK120518. K.L.L. is supported by the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation.
Publisher Copyright:
© 2021 Wolters Kluwer Health. All rights reserved.
PY - 2021/7/23
Y1 - 2021/7/23
N2 - Background. The unplanned use of dual induction therapy with interleukin-2 receptor-blocking antibodies (IL2rAb) and antithymocyte globulin (ATG) may portend adverse outcomes. Methods. We used national transplant registry data to study clinical correlates and outcomes of single versus dual induction therapy in adult kidney-only transplant recipients in the United States (2005-2018). The risk of death and graft loss at 1 and 5 y, according to induction therapy type, was assessed using multivariate Cox regression analysis (adjusted hazard ratio with 95% upper and lower confidence limits [LCLaHRUCL]). Results. Of the 157 351 recipients included in the study, 67% were treated with ATG alone, 29% were treated with IL2rAb alone, and 5% were treated with both. Compared with IL2rAb alone, the strongest correlates of dual induction included Black race, calculated panel reactive antibody ≥80%, prednisone-sparing maintenance immunosuppression, more recent transplant eras, longer cold ischemia time, and delayed graft function. Compared with ATG alone, dual induction was associated with an increased 5-y risk of death (aHR 1.071.151.23; P < 0.0001), death-censored graft failure (aHR 1.051.131.22; P < 0.05), and all-cause graft failure (aHR 1.061.121.18; P < 0.0001). Conclusions. Further research is needed to develop risk-prediction tools to further inform optimal, individualized induction protocols for kidney transplant recipients.
AB - Background. The unplanned use of dual induction therapy with interleukin-2 receptor-blocking antibodies (IL2rAb) and antithymocyte globulin (ATG) may portend adverse outcomes. Methods. We used national transplant registry data to study clinical correlates and outcomes of single versus dual induction therapy in adult kidney-only transplant recipients in the United States (2005-2018). The risk of death and graft loss at 1 and 5 y, according to induction therapy type, was assessed using multivariate Cox regression analysis (adjusted hazard ratio with 95% upper and lower confidence limits [LCLaHRUCL]). Results. Of the 157 351 recipients included in the study, 67% were treated with ATG alone, 29% were treated with IL2rAb alone, and 5% were treated with both. Compared with IL2rAb alone, the strongest correlates of dual induction included Black race, calculated panel reactive antibody ≥80%, prednisone-sparing maintenance immunosuppression, more recent transplant eras, longer cold ischemia time, and delayed graft function. Compared with ATG alone, dual induction was associated with an increased 5-y risk of death (aHR 1.071.151.23; P < 0.0001), death-censored graft failure (aHR 1.051.131.22; P < 0.05), and all-cause graft failure (aHR 1.061.121.18; P < 0.0001). Conclusions. Further research is needed to develop risk-prediction tools to further inform optimal, individualized induction protocols for kidney transplant recipients.
UR - http://www.scopus.com/inward/record.url?scp=85112256925&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85112256925&partnerID=8YFLogxK
U2 - 10.1097/TXD.0000000000001190
DO - 10.1097/TXD.0000000000001190
M3 - Article
AN - SCOPUS:85112256925
SN - 2373-8731
VL - 7
SP - E736
JO - Transplantation Direct
JF - Transplantation Direct
IS - 8
ER -