Patients undergoing kidney transplant after a previous nonrenal organ transplant (NRT) present a small but emerging subpopulation of kidney transplant recipients. Little is known about the suitable induction therapy in this complicated setting.

Using our validated transplant registry database called DIVAT, which prospectively records patient data from 6 French transplant centers, we studied a cohort of 128 patients who underwent a kidney transplant between 1996 and 2013 after having received a NRT. Among these patients, 72 and 56 received ATG and anti-IL-2R induction therapy, respectively. We aim at comparing the overall graft survival (time from renal transplant to return to dialyse or death) between the 2 groups.

A univariate analysis of more than 20 variables was performed using log rank test of Kaplan-Meier survival curve and Cox univariate analysis. Then a Cox multivariate model including the most clinical relevant variables as well as those associated with p<0.2 in the univariate analysis was done and showed that patients treated with ATG have 3 times greater risk of return to dialyse or death compared to patients treated with anti-IL-2R (HR: 3.1, 95%CI: 1.22-7.85, p=0.017). None of the other variables in the Cox multivariate analysis were significantly associated with overall graft survival, such as patient age (95%CI: 0.97-1.03, p=0.927), donor age ≥ 55 yr (95%CI: 0.88-4.66, p=0.097), cadaveric donor (95%CI: 0.74-49.44, p=0.093), the presence of panel reactive antibodies (95%CI: 0.66-2.82, p=0.405), the occurrence of an acute rejection episode (95%CI: 0.58-4.22, p=0.38), and time on dialysis before renal transplant ≥2 yr (95%CI: 0.73-3.42, p=0.242).

Despite the small number of patients, this study using multivariate statistical analysis suggests that ATG may not be a suitable induction therapy for patients undergoing kidney transplant after a previous NRT. A prospective study comparing different induction treatments in this particular subpopulation of kidney transplant recipients is warranted.

CITATION INFORMATION: Mai H, Trébern-Launay K, Legendre C, Kessler M, Rostaing L, Garrigue V, Morelon E, Brouard S, Giral M, Soulillou J.-P. Antithymocyte Globulin (ATG) versus Anti-interleukin-2 Receptor (Anti-IL-2R) as Induction Therapy for Kidney Transplantation After a Nonrenal Transplant. Am J Transplant. 2016;16 (suppl 3).

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