Multivariate analysis of antibody induction therapy and their associated outcomes in live donor kidney transplantation in the recent era

Clin Transplant. Mar-Apr 2012;26(2):351-8. doi: 10.1111/j.1399-0012.2011.01517.x. Epub 2011 Sep 29.

Abstract

The majority of kidney transplant recipients in the United States receive antibody induction, but its impact on outcomes in living donor transplant is not well-described. We used Organ Procurement and Transplant Network/United Network for Organ Sharing (OPTN/UNOS) data as of November 2009 to compare acute rejection (AR) and graft survival among all primary adult living donor kidney recipients of no antibody induction, antithymocyte globulin (ATG) and interleukin-2 receptor antagonists (IL-2RA) in an earlier era (1998-2002; n=21,919) and a later era (2003-2008, n=26,837). The incidence of AR in the overall cohort decreased from 18.5% in 1998 to 8% in 2008. From 1998 to 2002, antibody induction was associated with a decreased risk of acute rejection at six months (RR 0.67, 95% CI 0.62-0.72) and one yr (RR 0.71, 0.65-0.76), while in the recent era, induction was not associated with acute rejection at six months (RR 0.97, 0.88-1.07) or one yr (RR 1.01, 0.91-1.10). There was no difference in graft survival over five yr with antibody induction in either era. Although antibody induction was associated with a decreased risk of AR from 1998 to 2002, it was not associated with a decreased risk of acute rejection from 2003 to 2008, nor was it associated with a difference in graft survival in either era.

MeSH terms

  • Adolescent
  • Adult
  • Antilymphocyte Serum / administration & dosage*
  • Antilymphocyte Serum / immunology
  • Female
  • Graft Rejection / prevention & control
  • Graft Survival
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Kidney Transplantation / immunology*
  • Living Donors*
  • Male
  • Middle Aged
  • Receptors, Interleukin-2 / antagonists & inhibitors*
  • Young Adult

Substances

  • Antilymphocyte Serum
  • Immunosuppressive Agents
  • Receptors, Interleukin-2