Clinical Factors That Determine the More Appropriate Induction Agent: ATG versus IL-2 Receptor Antagonists.

S. Bae, A. Massie, S. DiBrito, X. Luo, L. Kucirka, F. Al Ammary, D. Segev.

Johns Hopkins, Baltimore, MD.

Meeting: 2016 American Transplant Congress

Abstract number: C36

Keywords: Antilymphocyte antibodies, Induction therapy, Interleukin-2 receptor, Multivariate analysis

Session Information

Session Name: Poster Session C: Clinical Science - Kidney Immunosuppression: Induction Therapy

Session Type: Poster Session

Date: Monday, June 13, 2016

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

Antithymocyte globulin (ATG) is recommended over IL-2 receptor antagonist (IL2) in high-risk recipients for induction immunosuppression. However, “high-risk” status has not been defined in an evidence-based manner and the choice of induction agent depends on clinical judgment. We aimed to identify recipient subgroups that displayed distinctively superior or inferior survival with ATG versus IL2.

Methods: Using SRTR data, we studied 60,069 deceased-donor kidney transplant recipients between 2005-2014 who were prescribed ATG or IL2 for induction, in addition to a calcineurin inhibitor and antimetabolite for maintenance (considering steroid withdrawal as a potential confounder/effect modifier). We built Cox models for all-cause graft loss with interaction terms of ATG/IL2 and covariates.

Results: Overall, ATG was associated with decreased hazard of graft loss compared with IL2 (aHR=_0.910.95_0.99). However, the effectiveness of ATG on graft survival varied by recipient age, cause of ESRD, and HCV status. ATG was associated with a suggestively lower hazard of graft loss (aHR=_0.840.93_1.03) among young adults (19-40y), but with a suggestively higher hazard (aHR=_0.971.15_1.36)among pediatric recipients (0-18y; p-value for interaction=0.03). The impact of ATG versus IL2 also varied by cause of ESRD, with a greater value of ATG seen in those with ESRD due to diabetes or glomerulonephritis (aHR=_0.840.90_0.97 and _0.830.91_0.99) than in those with ESRD due to hypertension or other causes (aHR=_0.921.00_1.09 and _0.941.01_1.09; Table). ATG was associated with a significantly lower hazard of graft loss (aHR=_0.710.81_0.92) among HCV(+) recipients, but not (aHR=_0.930.97_1.02) among HCV(-) recipients (p for interaction=0.005).

Conclusion: Recipient age, cause of ESRD, and HCV status may need to be considered when choosing induction agent. These findings may help inform clinical judgment of induction choice in a more data-driven manner than is currently practiced.

CITATION INFORMATION: Bae S, Massie A, DiBrito S, Luo X, Kucirka L, Al Ammary F, Segev D. Clinical Factors That Determine the More Appropriate Induction Agent: ATG versus IL-2 Receptor Antagonists. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Bae S, Massie A, DiBrito S, Luo X, Kucirka L, Ammary FAl, Segev D. Clinical Factors That Determine the More Appropriate Induction Agent: ATG versus IL-2 Receptor Antagonists. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-factors-that-determine-the-more-appropriate-induction-agent-atg-versus-il-2-receptor-antagonists/. Accessed November 21, 2024.

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