Early Rejection Outcomes with IL-2 vs. ATG Induction among Kidney Transplant Recipients Induction Differences with Early Steroid Withdrawal

C. Burelli, A. Szczepanik, K. Yadav, E. Sanchez, M. Debroy, V. Humphreville, J. Rabets, A. Padiyar, N. Sarabu, A. Jittirat, A. Palanisamy, K. Chavin

University Hospitals Cleveland Medical Center, Cleveland, OH

Meeting: 2019 American Transplant Congress

Abstract number: A274

Keywords: Immunosuppression, Induction therapy, Kidney transplantation, Rejection

Session Information

Session Name: Poster Session A: Kidney Immunosuppression: Novel Regimens and Drug Minimization

Session Type: Poster Session

Date: Saturday, June 1, 2019

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Hall C & D

*Purpose: Early steroid withdrawal in kidney transplant (Ktx) patients is controversial and has demonstrated an increased risk of acute rejection with similar long-term outcomes. Data assessing impact of induction agents on the risk of biopsy proven acute rejection (BPAR) in this setting are conflicting. As part of a quality initiative, we standardized our induction protocol (Table). We compared the risk of early BPAR among Ktx patients receiving induction with basiliximab (IL-2) vs. antithymocyte globulin (ATG) with and without steroids.

*Methods: Adult Ktx between 11/1/2017 and 10/31/2018 were included in this single-center, prospective cohort study. Primary outcome was incidence of BPAR at 1 month post-tx. Secondary outcomes included incidence of delayed graft function (DGF), cytomegalovirus (CMV) infection, and BK viremia over an average follow-up period of 6 months. Chi-square and logistic regression analyses were performed.

*Results: Of 86 Ktx performed, 38 patients received IL-2 induction, 48 patients received ATG. Steroids were withdrawn in 23 IL-2 patients and 20 ATG patients ATG. There was no statistically significant difference in the incidence of 1 month BPAR between patients receiving IL-2 or ATG with or without steroids (Figure). In multivariate logistic regression analysis; type of induction agent, steroid continuation, or FK levels at various time points were not predictive of 1 month BPAR. Rates of DGF (31.6% vs. 27.7%; p=0.81), CMV infection (2.6% vs. 10.6%; p=0.22), and BK viremia (7.9% vs. 14.9%; p=0.50) were not significantly different between IL-2 and ATG cohorts. During follow-up, in the entire cohort, there was 1 graft loss (technical) and 1 patient death (malignancy; ATG group).

*Conclusions: There was a trend towards a higher BPAR rate in the IL-2 cohort, particularly among IL-2 patients with steroid withdrawal. Although not statistically significant, due to small sample size, these differences may be clinically significant. Further investigation with larger studies is warranted.

Table
IL-2 If all are true:	ATG If any are true:	Steroid Continuation If any are true:
1^st tx	Re-tx	On steroids at time of tx
Age ≥50	Age <50	Re-tx
PRA <80%	PRA ≥80%	PRA >80%
KDPI ≤85%	KDPI >85%	Lupus, IGA Nephropathy, FSGS
– Xm	+ Xm	DGF
	Pediatric en bloc

To cite this abstract in AMA style:

Burelli C, Szczepanik A, Yadav K, Sanchez E, Debroy M, Humphreville V, Rabets J, Padiyar A, Sarabu N, Jittirat A, Palanisamy A, Chavin K. Early Rejection Outcomes with IL-2 vs. ATG Induction among Kidney Transplant Recipients Induction Differences with Early Steroid Withdrawal [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/early-rejection-outcomes-with-il-2-vs-atg-induction-among-kidney-transplant-recipients-induction-differences-with-early-steroid-withdrawal/. Accessed May 11, 2025.

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