Background: Approximately 20% of all renal transplants performed in the US in 2014 occurred in elderly patients. Elderly patients are known to be at higher risk for malignancies and infectious complications given the reduction of immune surveillance that occurs with age. The appropriate induction agent for the elderly population is yet to be determined. To date, there are no studies comparing patient and graft outcomes based on rabbit anti-thymocyte globulin (rATG) or IL-2 receptor antagonist (IL-2 RA) induction in this population.

Methods: A retrospective cohort study was performed in elderly patients (age 65 or older) who received either induction with rATG (thymoglobulin) or IL-2 RA (either basiliximab or daclizumab) between January 2001 and January 2015 at a single transplant center. Baseline characteristics and renal transplant outcomes were analyzed between the 2 groups using either a Chi-square test or Student's t-test where appropriate. Analysis of one-year post-transplant outcomes included the following: delayed or slow graft function, serum creatinine (SCr), glomerular filtration rate (GFR; based on the MDRD equation), acute rejection, and graft and patient survival. Additionally, CMV viremia, BK viremia, serious infection, and malignancy were compared between the 2 groups. Kaplan-Meier event curves were constructed for patient and graft survival.

Results: A total of 142 elderly renal transplant recipients met inclusion criteria. Mean age at the time of transplant was slightly higher in the IL-2 RA group compared to rATG group (69.4 vs 68.0; P = 0.0167). Significantly more patients in the rATG group were African American (64% vs 15%; P < 0.0001). Acute rejection at 1-year was 15% for both groups. Although, SCr was slightly higher with rATG (1.64 vs 1.36 mg/dl; P = 0.0634), there was no difference in GFR at 1-year. Kaplan-Meier survival analyses showed no difference between the two induction agents for graft or patient survival. There was also no difference in CMV viremia, serious infection, or malignancy. Incidence of BK viremia was significantly higher in patients who received rATG (27% vs 13%: P = 0.04).

Conclusions: Induction with rATG or IL-RA in elderly transplant recipients showed similar efficacy in terms of preserving patient and graft survival. However, the rATG group experienced more BK viremia and SCr elevation.

CITATION INFORMATION: Jasiak N, Thielke J, Chen J, Hilal N, Salah S, Wu D, Benedetti E, West-Thielke P. Outcomes in Elderly Renal Transplant Recipients Using Thymoglobulin or Interleukin-2 Receptor Antagonist Induction. Am J Transplant. 2016;16 (suppl 3).

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