Kidneys from donors with acute renal failure (ARF) are often discarded due to concerns for DGF and graft failure. Induction immunosuppression can be used to abrogate these risks, but practices vary. We investigated the national outcomes of induction in recipients of ARF donor kidneys, hypothesizing that induction would improve outcomes.

Methods: Data from the Scientific Registry of Transplant Recipients from January 2003-June 2016 identified 115,194 deceased donor transplants, with 8134 (7.0%) receiving ARF donor kidneys (terminal Cr>2.0). Multivariate Cox and logistic regressions were used to estimate the effect of center-level induction use on acute rejection (AR) in the first post-transplant year, graft failure (GF), and patient mortality (PM).

Results: Of those receiving ARF kidneys, 82% received concurrent antibody induction. Probabilities of AR, GF, and PM were reduced with induction (Table 1). ARF recipients had a greater reduction in GF risk (HR=0.97 vs. 0.99; interaction p-value=0.0283) (Figure 1) and AR odds (OR=0.91 vs. 0.98, interaction p-value<0.0001) per 10% increase in center induction use than non-ARF recipients. ARF recipients also had a marginal reduction in PM risk with induction (interaction p-value=0.3115). Comparing agents in ARF recipients, depleting agents resulted in superior outcomes compared to non-depleting agents for AR (OR=0.88 vs. 1.02), but not other outcomes.Conclusion: While beneficial for recipients of both ARF and non-ARF kidneys, induction has more robust associations with GF and AR for recipients of ARF kidneys. Increased center use of induction in this cohort could improve outcomes and expand the donor pool for the waitlist population.

CITATION INFORMATION: Barrett M, Smith A, Woodside K, Sung R. Benefits of Induction in Recipients of Acute Renal Failure Donor Kidneys. Am J Transplant. 2017;17 (suppl 3).

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