Introduction: There is no data on the risks and benefits of induction immunosuppression in simultaneous liver/kidney transplant (SLKT) patients.

Methods: We analyzed all SLKT performed between 1996 and 2016 using the Organ Procurement and Transplant Network (OPTN) registry. Patients were divided into 3 groups based upon their induction regimen: T cell depleting (r-ATG); IL2 receptor blockers (IL2RB) and no-induction (NI).

Results: Among 5180 patients, 18% received r-ATG, 32% received IL2RB and 50% received NI. Patients in the r-ATG group were more likely to be females (40% vs 32.5% in IL2RB vs 34% in NI; p<0.001), less likely to have hepatitis C (32% vs 38% in IL2RB vs 38% in NI; p<0.001), had lower MELD score (28 ±8, vs 29±8 in IL2RB vs 30±8 in NI; p<0.001) and were more likely to be on steroid sparing protocol (37% vs 12% vs 13%,; p<0.001). There was no difference in regards to recipient age, race, diabetes status, Kidney Donor Risk Index, allocation type (national/regional/local) and rates of acute rejection in the first year after transplant. At 5 years, patient survival was 74.1% in the r-ATG group, 81.4% in the IL2RB group and 76.0% in the NI group (p<0.001). Similar trends were seen for 5-year liver and kidney graft survivals. When patients were separated into 2 periods (period 1 from 1996 to 2006 and period 2 from 2006 to 2016), Chi-square test of Association showed that there were period effects. After controlling for period effects, in period 1, there was no difference in patient or kidney or liver survival between the 3 groups. However, in period 2, Kaplan Meier analysis showed difference in patient, kidney and liver survival (log rank p 0.0019, 0.013, 0.006 respectively), with rATG group having the worst patient and graft survival.

On multivariate analysis, when compared to NI, neither rATG nor IL2RB had a significant difference in survival risk. However, rATG induction was associated with worse kidney survival (HR=1.39; 95%CI=1.1-1.75; p=0.005) and liver survival (HR=1.36; 95%CI=1.06-1.75; p=0.02); while IL2RB had no impact on kidney and liver survivals as opposed to those who received no induction.

Conclusions: This analysis of SLKT from OPTN registry shows that rATG induction is associated with worse kidney and liver allograft survival. There seems to be a time period effect. This data should be interpreted with caution due to the inherent limitations of a registry based analysis.

CITATION INFORMATION: Gautam U., Reichman T., Yu J., Koppu S., Bandyopadhyay D., Levy M., Gupta G., Kamal L. Comparing Outcomes between Induction Immunosuppressive Therapies in Simultaneous Liver/Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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