Open AccessOutcomes of induction antibody therapies in the nonbroadly sensitized adult deceased donor kidney transplant recipients: a retrospective cohort registry analysis
Author(s) -
Santos Alfonso H.,
Li Yang,
Alquadan Kawther,
Ibrahim Hisham,
Leghrouz Muhannad A.,
Akanit Uraiwan,
Womer Karl L.,
Wen Xuerong
Publication year - 2020
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13583
Subject(s) - medicine , thymoglobulin , alemtuzumab , hazard ratio , odds ratio , incidence (geometry) , retrospective cohort study , kidney transplantation , gastroenterology , transplantation , confidence interval , physics , optics
Summary The outcomes of lymphocyte‐depleting antibody induction therapy (LDAIT), [thymoglobulin (ATG) or alemtuzumab (ALM)] versus interleukin‐2 receptor antagonist (IL‐2RA) in the nonbroadly‐sensitized [pretransplant calculated panel reactive antibody (cPRA), <80%] adult deceased donor kidney transplant recipients (adult‐DDKTRs) are understudied. In this registry, study of 55 593 adult‐DD‐KTRs, outcomes of LDAIT [(ATG, N = 32 985) and (ALM, N = 9429)], and IL‐2RA ( N = 13 179) in <10% and 10–79% cPRA groups was analyzed. Adjusted odds ratio (aOR) of one‐year biopsy‐proven acute rejection (BPAR) was lower; while, aOR of 1‐year composite of re‐hospitalization, graft loss, or death was higher with LDAIT than IL2‐RA in both cPRA groups. Adjusted odds ratio (aOR) of delayed graft function was higher with LDAIT than IL‐2RA in the <10% cPRA group. Adjusted hazard ratio (aHR) of 5‐year death‐censored graft loss (DCGL) in both <80% cPRA groups seemed higher with ALM than other inductions [(<10% cPRA: ALM versus IL2RA, aHR = 1.11, 95% CI = 1.00–1.23 and ATG versus ALM: aHR = 0.84, 95% CI = 0.77–0.91; 10–79% cPRA: ALM versus IL2RA, aHR = 1.29, 95% CI = 1.02–1.64; and ATG versus ALM, aHR = 0.83, 95% CI = 0.70–0.98)]. Five‐year aHR of death did not differ among induction therapies in both cPRA groups. In nonbroadly sensitized adult‐DDKTRs, LDAIT is more protective against 1‐year BPAR (not 5‐year mortality) than IL‐2RA; the trend of a higher 5‐year DCGL risk with ALM than ATG or IL‐2RA needs further investigation.