Date: Monday, June 13, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
African Americans (AA) are at a higher risk of acute rejection and graft loss compared to non-AA kidney transplant (KT) recipients. Guidelines specify induction choices by recipient factors. However, the role of donor factors in this decision-making has not been explored, particularly in low-risk AA recipients. We aimed to compare outcomes of ATG versus IL2 in low-risk AA KT, stratified by KDPI.
METHODS: Using OPTN data, we identified 3870 low-risk AA (first-time, KT alone, 0% PRA, HIV-negative, HCV-negative, CIT<24h) deceased-donor KT recipients between 2003-2014 who received ATG or IL2 induction in addition to Tacrolimus (Tac), Mycophenolate (MPA), and steroid immunosuppression. We built Cox models for all-cause graft loss (ACGL), death-censored graft loss (DCGL), and mortality, as well as logistic regression models for acute rejection at 1 year (AR). Patients were stratified into 3 KDPI categories (low: 0-34, moderate: 35-85, high: 86+)
|Table 1: KDPI Strata||ATG (N=2593)||IL2 (N=1277)|
RESULTS: Compared to ATG, IL2 in low, moderate, and high-KDPI KT was not associated with a significant difference in ACGL (aHR=0.811.031.30, p=0.7, 0.931.11.31, p=0.3, and 0.680.951.31, p=0.8); DCGL (aHR=0.831.131.53, p=0.6, 1.001.261.58, p=0.04, and 0.540.861.37, p=0.5); or mortality (aHR=0.741.011.39, p=1.0, 0.720.901.12, p=0.4, and 0.670.991.47, p=1.0). However, IL2 was associated with increased risk of AR in moderate-KDPI (aOR= 1.121.512.02, p=0.001) and a trend toward AR in high-KDPI (aOR= 0.651.272.5, p=0.5), but not in low-KDPI KT (aOR= 0.671.081.74, p=0.8) .
CONCLUSION: ATG was not associated with better outcomes compared to IL2 in the low-KDPI category when using Tac/MPA/prednisone in a low-risk AA KT population. These results suggest a low-KDPI should not influence choice of induction, while in moderate and high-KDPI, ATG would be the preferred choice in low-risk AA KT recipients.
CITATION INFORMATION: Al Ammary F, Bae S, Massie A, Dagher N, King E, Wiseman A, Segev D. Induction Therapy in Low Risk African American Kidney Transplant Recipients: Donor Factors. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Al F, Bae S, Massie A, Dagher N, King E, Wiseman A, Segev D. Induction Therapy in Low Risk African American Kidney Transplant Recipients: Donor Factors. [abstract]. Am J Transplant. 2016; 16 (suppl 3). http://atcmeetingabstracts.com/abstract/induction-therapy-in-low-risk-african-american-kidney-transplant-recipients-donor-factors/. Accessed January 20, 2018.
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