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Effects of antibody induction on transplant outcomes in human leukocyte antigen zero-mismatch deceased donor kidney recipients.

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

    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