Date: Sunday, June 3, 2018
Session Time: 4:30pm-6:00pm
Presentation Time: 4:30pm-4:42pm
Location: Room 4C-3
Introduction: There is no published data on the risks and benefits of Induction immunosuppression in simultaneous heart/kidney transplant (SHKT) patients.
Methods: We analyzed all SHKT performed between 1987-2015 using the national OPTN registry. Patients were stratified in to three groups based upon their induction regimen: anti-thymocyte globulin (ATG); IL2 receptor blockers (IL2RB) and no-induction (NI). Inverse probability weighted propensity (IPW) scoring was utilized to minimize maintenance immunosuppresssion choice, selection, regional and era (time of transplant) biases.
Results: A total of 1107 patients were identified of which 312 (28%) received NI; 332 (30%) received IL2RB; and, 463 (42%) received ATG. In general patients were demographically well-matched across the three groups. There were regional differences in the use of induction regimens with Region 2 being more likely to use NI and Region 5 more likely to use ATG. Compared with NI group, both IL2RB and ATG groups had a lower risk of acute kidney transplant rejection respectively (17.6% vs 7.4% vs 10.9%; p=0.007). The log-rank tests for Kaplan-Meier curves showed that one- and five-year patient survival, and death-censored kidney graft and heart graft survivals were superior for ATG group compared with the IL2RB and NI group. IPW analysis showed that compared with the ATG group, 1 and 5 year kidney, heart and patient survivals were similar to IL2RB group but superior to the NI group.
|Hazard Ratio (95%CI)||p-value|
|IL2RB (vs rATG)|
|5-Yeart Heart Survival||1.18 (0.95-1.46)||0.11|
|5-Year Kidney Survival||1.03 (0.85-1.26)||0.70|
|5-Year Patient Survival||1.16 (0.94-1.44)||0.16|
|No Induction (vs rATG)|
|5-Year Heart Survival||1.45 (1.18-1.77)||<0.001|
|5-Year Kidney Survival||1.23 (1.02-1.48)||0.03|
|5-Year Patient Survival||1.46 (1.19-1.78)||<0.001|
Conclusions: In this OPTN analysis of SHKT patients, induction immunosuppression with either IL2RB or ATG was associated with superior long-term graft and patient survivals compared with no induction. These findings should be interpreted with caution as there might be significant between-group differences that cannot be accounted for due to the inherent limitations of a registry analysis.
CITATION INFORMATION: Moinuddin I., Yu J., Kang L., Bhati C., Bandyopadhyay D., King A., Kumar D., Kamal L., Tang D., Yakubu I., Gupta G. Comparing Outcomes between Induction Immunosuppressive Therapies in Simultaneous Heart/Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Moinuddin I, Yu J, Kang L, Bhati C, Bandyopadhyay D, King A, Kumar D, Kamal L, Tang D, Yakubu I, Gupta G. Comparing Outcomes between Induction Immunosuppressive Therapies in Simultaneous Heart/Kidney Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/comparing-outcomes-between-induction-immunosuppressive-therapies-in-simultaneous-heart-kidney-transplantation/. Accessed February 19, 2020.
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