Background: 12% of kidney transplant recipients each year have undergone previous transplantation. The optimal induction therapy in the subgroup of patients who are on maintenance immunosuppression (IS) at the time of transplant has not been studied. Here, we evaluate differences in outcomes using different induction agents.

Methods: We identified 45 patients who underwent repeat kidney transplantation between January 2006 and December 2011 on maintenance IS due to a non-renal functioning organ or tapering IS. 20 patients received basiliximab (BSX) and 25 received lymphocyte depleting (LD) agents (13 thymoglobulin, 12 alemtuzumab). Patients were followed for 35.9±21.6 months post-transplant.

Results: Patient characteristics are summarized in Table 1.

There were 3 (15%) graft losses in the BSX and 2 (8%) in the LD group. Graft survival during the study period was comparable between the 2 (p=0.57). Patients on BSX experienced a higher rate of acute cellular rejection (ACR) during the early post-transplant period (BSX 35% vs LD 12%, p=0.14) (Figure 1).

The incidence of transplant glomerulopathy was comparable between the 2 groups (BSX 5% vs LD 12%, p=0.6). Graft function, evidenced by SCr was also similar between groups at 3 months (1.6±0.8 vs 1.4±0.5, p=0.34); 6 months (1.7±0.8 vs 1.6±0.9, p=0.8); 1 year (1.6+0.9 vs 1.3+0.4, p=0.17); and 3 years (1.5+0.7 vs 1.7+1.5, p=0.7).

Conclusion: Our results suggest that although the rate of early ACR may be higher with BSX induction in patients undergoing repeat kidney transplantation while on maintenance IS, graft function, and short-intermediate graft survival are similar between BSX and LD induction. Further studies are needed to better determine the optimal induction therapy in this patient population.

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