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Depletional Induction Improves Kidney Graft and Patient Survival in Recipients with a Previous Liver Transplant in the United States

S. M. Riad1, N. Lim1, S. Jackson2, A. Matas3, J. Lake1

1Medicine, University of Minnesota, Minneapolis, MN, 2Fairview Health Services, Minneapolis, MN, 3Surgery, University of Minnesota, Minneapolis, MN

Meeting: 2020 American Transplant Congress

Abstract number: 257

Keywords: Immunosuppression, Induction therapy, Kidney/liver transplantation, Survival

Session Information

Session Name: Kidney Issues in Liver Transplantation

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

 Presentation Time: 3:15pm-3:27pm

Location: Virtual

*Purpose: Induction choices for kidney-after-liver transplant recipients are variable. We examined the impact of kidney induction types on kidney graft and patient survival in liver transplant recipients.

*Methods: We utilized the SRTR database through the end of 2015 to study kidney grafts and patients’ outcomes of all kidney-after-liver transplant recipients in the United States. We grouped recipients by induction type into three groups: depletional (N=687), non-depletional (n=558), and no induction (steroid only) (n=340). We studied patients and kidney allografts survival using Cox PH regression, with transplant center included as a random effect. These models were adjusted for kidney and liver induction, recipient and donor age, gender, HLA mismatches, payor type, living kidney, dialysis status, time from liver engraftment, hepatitis C status, DM at time of kidney transplant. Additionally, we analyzed a sub-cohort of recipients only on tacrolimus and mycophenolate maintenance.

*Results: Baseline characteristics are listed in (Table 1). The Kaplan-Meier curves showed statistically significant lower recipients and kidney allografts survival in the no induction group (Figures 1 and 2). Rejection and re-hospitalization rates were not statistically different between groups. In the multivariate model, as compared to no induction, only depletional induction was associated with improved patient survival [HR 0.70, 95% CI (0.53, 0.93), P 0.012] and kidney allograft survival [HR 0.62, 95% CI (0.39, 0.98), P 0.04]. Living-kidney donation was associated with improved kidney survival [HR 0.53, 95% CI (0.34, 0.82), P 0.004]. Results were similar in both cohorts.

*Conclusions: Depletional kidney induction was associated with improved patient and kidney graft survival for those with prior liver transplants. Depletional induction may be the preferred induction for kidney-after-liver transplant recipients.

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To cite this abstract in AMA style:

Riad SM, Lim N, Jackson S, Matas A, Lake J. Depletional Induction Improves Kidney Graft and Patient Survival in Recipients with a Previous Liver Transplant in the United States [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/depletional-induction-improves-kidney-graft-and-patient-survival-in-recipients-with-a-previous-liver-transplant-in-the-united-states/. Accessed May 11, 2025.

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