BACKGROUND: Antibody induction with polyclonal rabbit-antithymocyte globulin (rATG) or an interleukin-2 receptor antagonist (IL-2RA) is widely used in kidney transplantation. METHODS: Collaborative Transplant Study data from 38 311 first deceased-donor kidney transplants (2004-13) were analysed. Transplants were classified as 'normal risk' or 'increased risk' according to current guidelines. Cox regression analysis was applied to subpopulations of propensity score-matched recipients. RESULTS: rATG or IL-2RA induction was given to 64% of increased-risk and 53% of normal-risk patients, respectively. rATG and IL-2RA induction were each associated with reduced risk for graft loss versus no induction in increased-risk patients [hazard ratio (HR) 0.85, P = 0.046 and HR 0.89, P = 0.011, respectively]. The HR values for incidence of treated rejection in increased-risk patients for rATG and IL-2RA versus no induction were 0.75 (P = 0.037) and 0.77 (P < 0.001), respectively. In the normal risk subpopulation, neither induction therapy significantly affected the risk of graft loss or treated rejection. Hospitalization for infection was increased by rATG (P < 0.001) and IL-2RA (P < 0.001) induction. In contrast to patients transplanted during 1994-2003, among patients transplanted during 2004-13, rATG did not significantly affect the risk of non-Hodgkin's lymphoma versus no induction (P = 0.68). CONCLUSION: Induction therapy following kidney transplantation should be targeted to increased-risk transplants. In this analysis, a beneficial effect of antibody induction in normal-risk transplants could not be demonstrated.
BACKGROUND: Antibody induction with polyclonal rabbit-antithymocyte globulin (rATG) or an interleukin-2 receptor antagonist (IL-2RA) is widely used in kidney transplantation. METHODS: Collaborative Transplant Study data from 38 311 first deceased-donor kidney transplants (2004-13) were analysed. Transplants were classified as 'normal risk' or 'increased risk' according to current guidelines. Cox regression analysis was applied to subpopulations of propensity score-matched recipients. RESULTS: rATG or IL-2RA induction was given to 64% of increased-risk and 53% of normal-risk patients, respectively. rATG and IL-2RA induction were each associated with reduced risk for graft loss versus no induction in increased-risk patients [hazard ratio (HR) 0.85, P = 0.046 and HR 0.89, P = 0.011, respectively]. The HR values for incidence of treated rejection in increased-risk patients for rATG and IL-2RA versus no induction were 0.75 (P = 0.037) and 0.77 (P < 0.001), respectively. In the normal risk subpopulation, neither induction therapy significantly affected the risk of graft loss or treated rejection. Hospitalization for infection was increased by rATG (P < 0.001) and IL-2RA (P < 0.001) induction. In contrast to patients transplanted during 1994-2003, among patients transplanted during 2004-13, rATG did not significantly affect the risk of non-Hodgkin's lymphoma versus no induction (P = 0.68). CONCLUSION: Induction therapy following kidney transplantation should be targeted to increased-risk transplants. In this analysis, a beneficial effect of antibody induction in normal-risk transplants could not be demonstrated.
Authors: Neel Koyawala; Jeffrey H Silber; Paul R Rosenbaum; Wei Wang; Alexander S Hill; Joseph G Reiter; Bijan A Niknam; Orit Even-Shoshan; Roy D Bloom; Deirdre Sawinski; Susanna Nazarian; Jennifer Trofe-Clark; Mary Ann Lim; Jesse D Schold; Peter P Reese Journal: J Am Soc Nephrol Date: 2017-03-20 Impact factor: 10.121
Authors: Rhys D R Evans; James H Lan; Matthew Kadatz; Sandeep Brar; Doris T Chang; Lachlan McMichael; Jagbir Gill; John S Gill Journal: Clin J Am Soc Nephrol Date: 2022-02 Impact factor: 10.614
Authors: Nassim Kamar; Benoit Lepage; Lionel Couzi; Laetitia Albano; Antoine Durrbach; Vincent Pernin; Laure Esposito; Anne Laure Hebral; Amandine Darres; Moglie Lequintrec; Elisabeth Cassuto; Pierre Merville; Nicolas Congy; Arnaud Del Bello Journal: Kidney Int Rep Date: 2020-06-02
Authors: Vikas R Dharnidharka; Abhijit S Naik; David A Axelrod; Mark A Schnitzler; Zidong Zhang; Sunjae Bae; Dorry L Segev; Daniel C Brennan; Tarek Alhamad; Rosemary Ouseph; Ngan N Lam; Mustafa Nazzal; Henry Randall; Bertram L Kasiske; Mara McAdams-Demarco; Krista L Lentine Journal: Transpl Int Date: 2017-11-02 Impact factor: 3.782