Economic benefits of T cell-depleting induction in deceased donor kidney transplant recipients

Thymoglobulin (TMG) induction improves long-term outcomes in high-immunologic-risk kidney transplant (KTx) by reducing acute cellular rejection. However, routine use of TMG in lower-immunologic-risk KTx is controversial, given concerns about posttransplant infectious complications and added health care expenditures. United States Renal Data System data were examined to compare real-world clinical and economic outcomes—including 3-year median Medicare expenditures, incidence of key adverse events, and allograft survival—in a cohort of Medicare-insured deceased donor KTx recipients (2006-2020) treated with TMG or interleukin 2 receptor antibody (IL2rAb) induction. Treatment cohorts were constructed using propensity score matching on donor and recipient characteristics, yielding well-balanced groups of 15 929 recipients per arm. In the propensity score-matched cohort, mortality was lower with TMG (9.3% vs 10.0%, P < .05), whereas 3-year graft failure rates did not differ (15.1% vs 15.1%). Acute rejection, bone fracture, pneumonia, and sepsis were significantly higher in the IL2rAb group ( P < .05). TMG induction was associated with a mean cost savings of $27 526 ($20 532-$35 928). Sensitivity analyses found no subgroups with significantly higher costs with TMG. Although confounding by indication cannot be excluded, these data suggest that broader use of TMG in place of IL2rAb has the potential to reduce health care expenditures and decrease the incidence of some posttransplant complications.