Background: We hypothesize that 2-haplotype matched white living kidney transplant recipients carry a low immunologic risk for rejection, and therefore do not give induction therapy and have the calcineurin inhibitors (CNIs) withdrawn by 6-12 months after transplant per protocol. The purpose of the present study was to compare the efficacy of this policy with the use of induction therapy nationally in this patient population.

Materials/Methods: We compared 2-haplotype matched white living kidney transplant recipients from our center(induction avoidance) to those in the United Network for Organ Sharing (UNOS) database, transplanted between 2000 and 2013 who did receive induction with thymoglobulin, alemtuzumab, or basiliximab.

Results: Induction avoidance patients (n=58) were more likely to be female than the thymoglobulin patients (n=1163), the alemtuzumab patients (n=358), or the basiliximab patients (n=1109) (P=0.0941). Recipient and donor age, delayed graft function, and rejection at one year were similar among the groups. Using adjusted multivariate analysis, induction avoidance was not a risk factor for kidney allograft failure compared to basiliximab induction HR 0.797 (CI 0.401-1.586, p= 0.83). In addition, thymoglobulin and alemtuzumab were not superior to basiliximab induction (P=0.22, P=0.21 respectively). Life-table analyses showed similar results (table 1). In the induction avoidance group, CNI withdrawal at one year was completed in 28 patients per protocol and was not a risk factor for allograft failure compared to patients who are on CNI longer than 1-year (n=30) with a HR 1.827 (P=0.4)

Conclusion: 2-haplotype matched white living kidney recipients require less immunosuppression, and have lower risk of immunologic events. Our data suggest induction avoidance is safe, and CNI withdrawal at 1-year provides equivalent graft survival.

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