Optimal Induction Therapy for Kidney Transplantation in Previous Heart Transplant Recipients: Analysis of OPTN/UNOS Registry.
Nephrology, Internal Medicine, Allegheny General Hospital, Pittsburgh, PA
Meeting: 2017 American Transplant Congress
Abstract number: B178
Keywords: Heart transplant patients, Kidney transplantation, Outcome
Session Information
Session Name: Poster Session B: Kidney Immunosuppression: Induction Therapy
Session Type: Poster Session
Date: Sunday, April 30, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
It is unclear as to which induction agent is optimal for kidney transplant (KT) in prior heart transplant (HT) recipients who are already immunocompromised from HT and will be exposed to different donor HLA for KT.
Using OPTN/UNOS thoracic and kidney database, we identified adult patients who underwent first HT from 2000 to 2014 followed by a first KT between 2001 and 2016. From this cohort, those who received no induction (n=54), an IL-receptor antibody (IL-2RA, n=107) or a depleting antibody (Thymoglobulin or alemtuzumab, n=87) induction for KT were identified. Depleting antibody recipients had more blacks, higher PRA, longer dialysis vintage and cold ischemia time compared to IL-2RA recipients. Other variables including recipient age, diabetes, and HT to KT interval were similar. Majority were discharged on CNI and steroids. Outcomes comparing no induction vs. IL-2RA, no induction vs. depleting and IL-2RA vs. depleting inductions are shown in table. Adjusted odds for delayed graft function was significantly higher in depleting vs. no induction groups. Adjusted graft failure and patient death risks were similar across groups.
| Group 1 | Group 2 | Group 3 | ||||
| Outcomes | No induction | IL-2RA | No induction | Depleting | IL-2RA | Depleting |
| Dealyed graft function % | 7.4 | 19 | 7.4 | 22** | 19 | 22 |
| Adjusted OR with 95% CI | Control | 2.96
(0.84-10.33) |
Control | 4.56***
(1.14-18.3) |
Control | 1.29
(0.61-2.73) |
| 1-year rejection % | 17 | 10 | 17 | 8.6 | 10 | 8.6 |
| Adjusted OR with 95% CI | Control | 0.38
(0.13-1.09) |
Control | 0.52
(0.17-1.53) |
Control | 1.13
(0.39-3.24) |
| 5-year graft survival % | 41 | 60 | 41 | 43 | 60 | 43 |
| Adjusted HR with 95% CI[dagger] | Control | 0.71
(0.39-1.29) |
Control | 0.74
(0.40-1.35) |
Control | 1.37
(0.81-2.32) |
| 5-year patient survival % | 40 | 66* | 40 | 48 | 66 | 48 |
| Adjusted HR with 95% CI[dagger] | Control | 0.64
(0.33-1.25) |
Control | 0.75
(0.41-1.36) |
Control | 1.48
(0.80-2.72) |
| p-values:*=0.05;**=0.02;***=0.03;[dagger]=graft failure/patient death risks | ||||||
Conclusions: Lack of observed graft and patient survival benefits seen with any induction for KT in prior HT recipients could be related to the risks of enhanced immunosuppression.
CITATION INFORMATION: Sampaio M, Hussain S, Chopra B, Sureshkumar K. Optimal Induction Therapy for Kidney Transplantation in Previous Heart Transplant Recipients: Analysis of OPTN/UNOS Registry. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Sampaio M, Hussain S, Chopra B, Sureshkumar K. Optimal Induction Therapy for Kidney Transplantation in Previous Heart Transplant Recipients: Analysis of OPTN/UNOS Registry. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/optimal-induction-therapy-for-kidney-transplantation-in-previous-heart-transplant-recipients-analysis-of-optnunos-registry/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress