Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;17(2):271-279.
doi: 10.2215/CJN.09170721.

Use and Outcomes of Induction Therapy in Well-Matched Kidney Transplant Recipients

Rhys D R Evans  1 , James H Lan  1   2   3 , Matthew Kadatz  1   2 , Sandeep Brar  1 , Doris T Chang  4 , Lachlan McMichael  1 , Jagbir Gill  3   4   5   6 , John S Gill  7   4   8
Affiliations

Use and Outcomes of Induction Therapy in Well-Matched Kidney Transplant Recipients

Rhys D R Evans et al. Clin J Am Soc Nephrol. 2022 Feb.

Erratum in

Abstract

Background and objectives: The optimal induction treatment in low-immune risk kidney transplant recipients is uncertain. We therefore investigated the use and outcomes of induction immunosuppression in a low-risk cohort of patients who were well matched with their donor at HLA-A, -B, -DR, -DQB1 on the basis of serologic typing.

Design, setting, participants, & measurements: Our study was an observational study of first adult kidney-only transplant recipients in the United States recorded by the Organ Procurement and Transplant Network.

Results: Among 2976 recipients, 57% were treated with T cell-depleting antibodies, 28% were treated with an IL-2 receptor antagonist, and 15% were treated without induction. There was no difference in allograft survival, death-censored graft survival, or death with function between patients treated with an IL-2 receptor antagonist and no induction therapy. In multivariable models, patients treated with T cell-depleting therapy had a similar risk of graft loss from any cause, including death (hazard ratio, 1.19; 95% confidence interval, 0.98 to 1.45), compared with patients treated with an IL-2 receptor antagonist or no induction. The findings were consistent in subgroup analyses of Black recipients, patients grouped by calculated panel reactive antibody, and donor source. The incidence of acute rejection at 1 year was low (≤5%) and did not vary between treatment groups.

Conclusions: Use of induction therapy with T cell-depleting therapy or IL-2 receptor antagonists in first kidney transplant recipients who are well matched with their donor at the HLA-A, -B, -DR, -DQB1 gene loci is not associated with improved post-transplant outcomes.

Keywords: United States Renal Data System; acute rejection; immunosuppression; kidney transplantation; organ transplant.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Assembly of the study cohort. IL2-RA, IL-2 receptor antagonist.
Figure 2.
Figure 2.
Time to graft loss from any cause including death (A), graft loss censored for death (B), and death with a functioning graft (C) in zero HLA-A, -B, -DR, -DQB1 mismatched first adult kidney-only transplant recipients grouped by type of induction therapy. T cell depleting, n=1689; IL2-RAs, n=836; no induction, n=451. Supplemental Table 1 shows the number of patients at risk at various time points after transplantation.
Figure 3.
Figure 3.
Association of induction therapy with graft loss from any cause, including death, in selected patient subgroups. (A) Black recipients: T cell depleting, n=213; IL2-RAs/no induction, n=130. (B) Deceased donor recipients: T cell depleting, n=1255; IL2-RAs/no induction, n=639. (C) Living donor recipients: T cell depleting, n=434; IL2-RAs/no induction, n=648. Supplemental Table 2 shows the number of patients at risk at various time points after transplantation.
Figure 4.
Figure 4.
Graft loss from any cause, including death, in patients grouped by calculated panel reactive antibody (cPRA). (A) cPRA 0% recipients: T cell depleting, n=661; IL2-RAs/no induction, n=805. (B) cPRA 1%–29% recipients: T cell depleting, n=215; IL2-RAs/no induction, n=161. (C) cPRA 30%–79% recipients: T cell depleting, n=413; IL2-RAs/no induction, n=215. (D) cPRA 80%–97% recipients: T cell depleting, n=258; IL2-RAs/no induction, n=66. (E) cPRA 98%–100%: T cell depleting, n=142; IL2-RAs/no induction, n=40. Supplemental Table 3 shows the number of patients at risk at various time points after transplantation.
See this image and copyright information in PMC

Comment in

References

    1. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group : KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 9[Suppl 3]: S1–S155, 2009 - PubMed
    1. Gebel HM, Bray RA, Nickerson P: Pre-transplant assessment of donor-reactive, HLA-specific antibodies in renal transplantation: Contraindication vs. risk. Am J Transplant 3: 1488–1500, 2003 - PubMed
    1. Pei R, Lee J-H, Shih N-J, Chen M, Terasaki PI: Single human leukocyte antigen flow cytometry beads for accurate identification of human leukocyte antigen antibody specificities. Transplantation 75: 43–49, 2003 - PubMed
    1. Cecka JM: Calculated PRA (CPRA): The new measure of sensitization for transplant candidates. Am J Transplant 10: 26–29, 2010 - PubMed
    1. Saran R, Robinson B, Abbott KC, Bragg-Gresham J, Chen X, Gipson D, Gu H, Hirth RA, Hutton D, Jin Y, Kapke A, Kurtz V, Li Y, McCullough K, Modi Z, Morgenstern H, Mukhopadhyay P, Pearson J, Pisoni R, Repeck K, Schaubel DE, Shamraj R, Steffick D, Turf M, Woodside KJ, Xiang J, Yin M, Zhang X, Shahinian V: US Renal Data System 2019 annual data report: Epidemiology of kidney disease in the United States. Am J Kidney Dis 75[Suppl 1]: A6–A7, 2020 - PubMed

Publication types

Grants and funding