Induction immunosuppression agents as risk factors for incident cardiovascular events and mortality after kidney transplantation

Low T cell counts and acute rejection are associated with increased cardiovascular events (CVEs); T cell–depleting agents decrease both. Thus, we aimed to characterize the risk of CVEs by using an induction agent used in kidney transplant recipients. We conducted a secondary data analysis of patients who received a kidney transplant and used Medicare as their primary insurance from 1999 to 2010. Outcomes of interest were incident CVE, all‐cause mortality, CVE‐related mortality, and a composite outcome of mortality and CVE. Of 47 258 recipients, 29.3% received IL‐2 receptor antagonist (IL‐2RA), 33.3% received anti‐thymocyte globulin (ATG), 7.3% received alemtuzumab, and 30.0% received no induction. Compared with IL‐2RA, there was no difference in the risk of CVE in the ATG (adjusted hazard ratio [aHR] 0.98, 95% confidence interval [CI] 0.92‐1.05) and alemtuzumab group (aHR 1.01, 95% CI 0.89‐1.16), but slightly higher in the no induction group (aHR 1.06, 95% CI 1.00‐1.14). Acute rejection did not modify this association in the latter group but did increase CVE by 46% in the alemtuzumab group. There was no difference in the hazard of all‐cause or CVE‐related mortality. Only in the ATG group, a 7% lower hazard of the composite outcome of mortality and CVE was noted. Induction agents are not associated with incident CVE, although prospective trials are needed to determine a personalized approach to prevention.