In kidney transplantation, donor-recipient HLA-DR mismatch is considered high immunologic risk portending inferior outcomes. We sought to explore the impact of induction type used on kidney transplant outcomes at varying levels of donor-recipient HLA-DR mismatches. Using OPTN/UNOS database, we identified adult living donor kidney (LDK) and deceased donor kidney (DDK) transplant recipients from 2001 to 2015 discharged on calcineurine inhibitor/mycophenolic acid maintenance following either depleting (Thymoglobulin/alemtuzumab) or non-depleting (basiliximab/daclizumab) antibody induction. Patients were then stratified by the number of donor-recipient HLA-DR mismatches (0,1 or 2) in both LDK and DDK groups. Using a Cox model adjusting for donor, recipient and transplant variables, overall and death-censored graft failure risks along with patient death risk were compared for depleting vs. non-depleting induction under each HLA-DR mismatch categories. Results are shown in table 1.

Our study showed significantly lower adjusted patient death risk associated with depleting vs. non-depleting peri-operative induction among DDK recipients and a trend towards the same in LDK recipients within the higher immune risk donor-recipient 2 HLA-DR allele mismatch categories. This survival benefit associated with depleting induction could likely be related to more robust suppression of ongoing immunological injury with better long-term allograft function, an observation more pronounced in DDK transplantation.

CITATION INFORMATION: Sureshkumar K., Hussain S., Chopra B. Induction Type and Outcomes in HLA-DR Mismatch Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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