Background: To date, studies addressing outcomes of depleting (i.e., rabbit anti-thymocyte globulin or rATG) vs. non-depleting (i.e., IL-2 receptor blocker or IL2RB) induction strategies in kidney transplant recipients (KTR) with delayed graft function (DGF) have been inconclusive.

Methods: A retrospective cohort study of deceased donor KTR with DGF from 1 Jan 2000 to 31 Dec 2009 (followed to 31 Dec 2010) was conducted using the Scientific Registry of Transplant Recipients. The Kaplan-Meier method was used to assess total graft failure, death-censored graft failure, death with graft function, and total mortality by induction type. Cox regression models were fitted to examine the independent association between the type of induction and outcome. To further control for confounding, analyses were repeated in both propensity score matched and paired donor subcohorts

Results: A total of 12,100 KTR were included in the study cohort (7,851 receiving rATG and 4,249 receiving IL2RB). Kaplan-Meier curves showed significant differences in total graft failure (P = 0.0001), death-censored graft failure (P = 0.04) death with graft function (P = 0.0005), and total mortality (P < 0.0001) in favor of rATG, with absolute differences ranging from 0.2% to 2.8% at 10-years post-transplant. There was a 7 to 11% increase in the adjusted hazard for all outcomes among recipients of IL2RB (vs. rATG), although only total graft failure and mortality reached statistical significance (Table). Similar increases in risk were observed in the propensity score matched and paired donor analyses.

Conclusion: Long-term outcomes are modestly superior in deceased donor KTR receiving rATG when compared to IL2RB in the setting of DGF. The role of DGF severity and/or duration as a modifier of the relation between the induction strategy and long-term outcomes requires further study.

Zaltzman, J.: Grant/Research Support, Genzyme. Kim, J.: Grant/Research Support, Genzyme.

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