Optimal Induction Therapy (IT) in Pancreas After Kidney Transplantation (PAK) According to Type of Kidney (kd) Donor and Patient Risk – A Registry Analysis
1University of Arizona, Tucson, AZ
2University of Arizona, Tucson, AZ.
Meeting: 2015 American Transplant Congress
Abstract number: 229
Keywords: Induction therapy, Pancreas transplantation
Session Information
Session Name: Concurrent Session: Optimizing Immunosuppression in Pancreas Transplantation
Session Type: Concurrent Session
Date: Monday, May 4, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 2:39pm-2:51pm
Location: Room 119-B
Purpose: Best IT in PAK recipients (rec) according to type of kd donor (LD vs. DD) and rec risk has not been determined.
Methods: Using the IPTR database, we analyzed primary deceased-donor (DD) PAKs that were performed between 2004 to 2013.
Group 1 (n=278) were PAKs with LD kd and low risk (0% PRA, White, Age >30, BMI < 30 kg/m2)
Group 2 (n=159), PAKs with LD kd and high risk (>10%PRA, Age <35)
Group 3 (n=248), PAKs with DD kd and low risk
Group 4 (n=72), PAKs with DD kd and high risk
We compared: (1) depleting (TMG, ATG), >= 4d; (2) depleting (TMG,ATG), < 4d; (3) depleting (Campath), 1d; (4) non-depleting, 1-2d; (5) no IT. Patients with depleting in combination with non-depleting antibodies were excluded. Only pts on maintenance therapy with tacrolimus and MMF were included.
Results: There were no significant differences in patient survival between the groups according to IT type. However, the following differences in pancreas graft survival were significant: (1) in PAKs with LD kd and low risk, the type of IT had no impact on survival; in PAKs with LD kd and high risk, graft survival rates were significantly higher when IT with depleting agents (TMG/ATG>=4d, Campath 1d) were used and significantly lower when no IT was used or IT with non-depleting or short-term TMG/ATG (<4d).
(2) in PAKs with DD kd and low as well as high risk, the type of IT had a significant impact on outcome: graft survival rates were higher when IT with depleting agents (TMG/ATG>=4d, Campath 1d) were used and lower when no IT was used or IT with non-depleting or short-term TMG/ATG (<4d).
Conclusions:. The results were surprising: (1) Pt survival was not impacted by IT irrespective of the type of kd donor or rec risk; (2) only in low-risk PAKs with LD kd, no impact on pancreas graft survival was noted between pts without or with IT; (3) however, pancreas graft survival in PAKs with LD kd and high risk as well as all DD kd (both low and high risk) was significantly higher when TMG/ATG>=4d or Campath=1d were used; no IT, non-depleting agents and TMG/ATG<4d resulted in significantly worse survival. Thus, only in low-risk PAKs with LD kd it does not matter if IT and what type of IT is used; however, all other PAKs (LD kd and high risk as well as all DD kd irrespective of risk) should receive IT with either TMG/ATG>=4d or Campath>1d for significantly higher pancreas graft survival.
To cite this abstract in AMA style:
Gruessner R, Gruessner A. Optimal Induction Therapy (IT) in Pancreas After Kidney Transplantation (PAK) According to Type of Kidney (kd) Donor and Patient Risk – A Registry Analysis [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/optimal-induction-therapy-it-in-pancreas-after-kidney-transplantation-pak-according-to-type-of-kidney-kd-donor-and-patient-risk-a-registry-analysis/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress