Abstract

BACKGROUND
We aimed to investigate the impact of antibody induction on outcomes in human leukocyte antigen (HLA) 0-mismatched deceased donor kidney recipients.
METHODS
Using the Organ Procurement and Transplant Network/United Network of Organ Sharing database as of November 2009, we identified 44,008 adult deceased donor kidney recipients who received primary kidney transplants alone between 2003 and 2008 (HLA 0 mismatch, n = 6274; ≥ 1 mismatch, n=37,734; median follow-up: 834 days). The impact of induction (thymoglobulin, interleukin-2 receptor antagonists [IL-2RA], or alemtuzumab; vs. no induction) on rejection (initial hospitalization, 6 months, first year), death-censored graft failure, and mortality were analyzed using multivariate logistic and Cox regression in the two groups. The impact of individual agents on outcomes was further analyzed in 0-mismatch recipients.
RESULTS
There was a decreased risk of rejection over the first 6 months for HLA 0-mismatch recipients of antibody induction (adjusted odds ratio=0.71, P=0.003), but this effect was not observed at 1 year; in comparison, induction was associated with a reduced risk of rejection over the first year for HLA-mismatched recipients (0.87, P<0.001). The use of thymoglobulin (0.72, P=0.02) and IL-2RA (0.67, P=0.004) was associated with a decreased risk of rejection compared with no-induction at 6 months but was not different at 1 year (thymoglobulin: 0.77, P=0.05; IL-2RA:0.81, P=0.11) in HLA 0-mismatched recipients. Induction was not associated with improved graft or patient survival in HLA 0-mismatch recipients.
CONCLUSION
In HLA 0-mismatch deceased donor recipients, antibody induction was associated with a decreased risk of rejection at 6 months posttransplant. Its use did not improve graft and patient survival over the follow-up period.

Links

Publisher Full Text

Authors

Kuo HT, Huang E, Emami S, Pham PT, Wilkinson AH, Danovitch GM, Bunnapradist S

Institution

Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Source

Transplantation 93:5 2012 Mar 15 pg 493-502

MeSH

Adolescent
Adult
Antibodies, Monoclonal, Humanized
Antilymphocyte Serum
Female
Graft Rejection
Graft Survival
HLA Antigens
Histocompatibility
Histocompatibility Testing
Humans
Immunosuppressive Agents
Kaplan-Meier Estimate
Kidney Transplantation
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Proportional Hazards Models
Receptors, Interleukin-2
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Tissue and Organ Procurement
Treatment Outcome
United States
Young Adult

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

22306574