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Induction Type and Outcomes in HLA-DR Mismatch Kidney Transplantation.
Transplant Proc 2019 Jul - Aug; 51(6):1796-1800TP

Abstract

BACKGROUND

In kidney transplantation, donor recipient human leukocyte antigen (HLA)-DR mismatch signals high immunologic risk and portends inferior outcomes. We compared the impacts of depleting vs non-depleting antibody induction on the outcomes in kidney transplant recipients (KTRs) at different levels of HLA-DR mismatches.

METHODS

Using the Organ Procurement and Transplantation Network/United Network for Organ Sharing database, we identified adult KTRs from 2001 to 2015 who received induction therapy with either depleting (thymoglobulin/alemtuzumab) or non-depleting (basiliximab/daclizumab) antibody and were discharged on calcineurin inhibitor/mycophenolic acid maintenance. Patients were then stratified by the number of donor-recipient HLA-DR mismatches (0, 1, 2) in both living donor (LD) and deceased donor (DD) KTRs. Under each HLA-DR mismatch category, long-term outcomes were compared for depleting vs non-depleting induction using a Cox model.

RESULTS

A total of 63,821 LD (HLA-DR mismatches: 0, n = 6945 [depleting = 4409, non-depleting = 2536]; 1, n = 19,557 [depleting = 13,558, non-depleting = 6019]; and 2, n = 10,727 [depleting = 7694, non-depleting = 3033]) and 64,922 DD (HLA-DR mismatches: 0, n = 13,915 [depleting = 10,124, non-depleting = 3791]; 1, n = 27,994 [depleting = 20,454, non-depleting = 7540]; and 2, n = 23,013 [depleting = 16,908, non-depleting = 6105]) KTRs were included in the analysis. Adjusted patient death risk was significantly lower in the depleting vs non-depleting antibody induction group among DD kidney recipients (hazard ratio 0.90, 95% CI 0.85-0.96, P = .001) and trended lower among LD kidney recipients (HR 0.88, 95% 0.79-1.01, P = .05) with 2 HLA-DR mismatches.

DISCUSSION

Our study found a patient survival benefit associated with the use of perioperative induction with depleting when compared to non-depleting antibody in KTRs with 2 HLA-DR mismatches and maintained on a calcineurin inhibitor/mycophenolic acid regimen.

Authors+Show Affiliations

Division of Nephrology and Hypertension, Medicine Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA. Electronic address: ksureshk@wpahs.org.Division of Nephrology and Hypertension, Medicine Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31399165

Citation

Sureshkumar, Kalathil K., and Bhavna Chopra. "Induction Type and Outcomes in HLA-DR Mismatch Kidney Transplantation." Transplantation Proceedings, vol. 51, no. 6, 2019, pp. 1796-1800.
Sureshkumar KK, Chopra B. Induction Type and Outcomes in HLA-DR Mismatch Kidney Transplantation. Transplant Proc. 2019;51(6):1796-1800.
Sureshkumar, K. K., & Chopra, B. (2019). Induction Type and Outcomes in HLA-DR Mismatch Kidney Transplantation. Transplantation Proceedings, 51(6), pp. 1796-1800. doi:10.1016/j.transproceed.2019.04.059.
Sureshkumar KK, Chopra B. Induction Type and Outcomes in HLA-DR Mismatch Kidney Transplantation. Transplant Proc. 2019;51(6):1796-1800. PubMed PMID: 31399165.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Induction Type and Outcomes in HLA-DR Mismatch Kidney Transplantation. AU - Sureshkumar,Kalathil K, AU - Chopra,Bhavna, PY - 2019/02/19/received PY - 2019/04/11/accepted PY - 2019/8/11/entrez SP - 1796 EP - 1800 JF - Transplantation proceedings JO - Transplant. Proc. VL - 51 IS - 6 N2 - BACKGROUND: In kidney transplantation, donor recipient human leukocyte antigen (HLA)-DR mismatch signals high immunologic risk and portends inferior outcomes. We compared the impacts of depleting vs non-depleting antibody induction on the outcomes in kidney transplant recipients (KTRs) at different levels of HLA-DR mismatches. METHODS: Using the Organ Procurement and Transplantation Network/United Network for Organ Sharing database, we identified adult KTRs from 2001 to 2015 who received induction therapy with either depleting (thymoglobulin/alemtuzumab) or non-depleting (basiliximab/daclizumab) antibody and were discharged on calcineurin inhibitor/mycophenolic acid maintenance. Patients were then stratified by the number of donor-recipient HLA-DR mismatches (0, 1, 2) in both living donor (LD) and deceased donor (DD) KTRs. Under each HLA-DR mismatch category, long-term outcomes were compared for depleting vs non-depleting induction using a Cox model. RESULTS: A total of 63,821 LD (HLA-DR mismatches: 0, n = 6945 [depleting = 4409, non-depleting = 2536]; 1, n = 19,557 [depleting = 13,558, non-depleting = 6019]; and 2, n = 10,727 [depleting = 7694, non-depleting = 3033]) and 64,922 DD (HLA-DR mismatches: 0, n = 13,915 [depleting = 10,124, non-depleting = 3791]; 1, n = 27,994 [depleting = 20,454, non-depleting = 7540]; and 2, n = 23,013 [depleting = 16,908, non-depleting = 6105]) KTRs were included in the analysis. Adjusted patient death risk was significantly lower in the depleting vs non-depleting antibody induction group among DD kidney recipients (hazard ratio 0.90, 95% CI 0.85-0.96, P = .001) and trended lower among LD kidney recipients (HR 0.88, 95% 0.79-1.01, P = .05) with 2 HLA-DR mismatches. DISCUSSION: Our study found a patient survival benefit associated with the use of perioperative induction with depleting when compared to non-depleting antibody in KTRs with 2 HLA-DR mismatches and maintained on a calcineurin inhibitor/mycophenolic acid regimen. SN - 1873-2623 UR - https://www.unboundmedicine.com/medline/citation/31399165/Induction_Type_and_Outcomes_in_HLA-DR_Mismatch_Kidney_Transplantation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(19)30319-7 DB - PRIME DP - Unbound Medicine ER -