Purpose: Delayed graft function (DGF) is defined as the need for dialysis within one week of transplantation and occurs in 20-50% of deceased-donor kidney transplant recipients. Although recovery from DGF often occurs within a few days, many cases may take weeks to months before the transplant function begins. The delay in function increases the complexity of recipient care, makes the diagnosis of acute rejection more difficult, prolongs length of stay, and increases hospital costs. Although several authors have proposed nomograms to predict DGF there is no identifiable strategy to ameliorate it, except for the possible use of a specific type of induction therapy called anti-thymocyte globulin.

Induction therapy is intravenous immunosuppressive therapy given at the time of transplant and has grown in use from 9% in 1992 to 59% in 1999. Currently, the two most utilized agents are basiliximab and anti-thymocyte globulin (ATG). The intent of all induction therapies is to lower the incidence of acute rejection; however, some reports suggest an additional effect of ATG to prevent or reduce the incidence of DGF. Whereas some previous reports have not shown an association of ATG with delayed graft function, others have found a potential protective effect of ATG therapy with DGF. Prior studies have been limited by an absence of assessment of metrics indicative of donor quality, which is a strong risk factor for DGF.

Methods: We retrospectively analyzed 407 subjects, of which 76 were mated (left and right kidney from the same donor), from a transplant database at a single center for all kidney transplants from 2008-2015. We examined all bivariate associations using t-test, Mann Whitney U, Kruskal-Wallis, and chi-squared test as appropriate. We used conditional logistic regression analysis as well as generalized estimating equation mixed models while adjusting for mated kidneys. We adjusted for age, sex, and race apriori, as well as cold ischemia time, warm ischemia time, and post-transplant creatinine in the model.

Summary of Results: There is no change in odds of delayed graft function when thymoglobulin is used as induction when compared to basiliximab. 1.0 (.32-3.12) (OR w 95% CI).

Conclusions: There is no association between thymoglobulin and delayed graft function when adjusting for multiple variables and controlling for donor quality by using a mated kidney analysis.

CITATION INFORMATION: Butler T, Hayde N. The Impact of Induction Therapy on Delayed Graft Function Following Kidney Transplantation in Mated Kidneys. Am J Transplant. 2017;17 (suppl 3).

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