Introduction: Induction agents have a profound effect on the immune milieu at the time of kidney transplantation. However, evaluation of their long-term effects on graft and patient outcomes are lacking. The development of post-transplant malignancy is thought to be related to the level of immunosuppression. This study examines the impact of induction agent on the development of post-transplant malignancy after kidney transplantation.

Methods: The University of Wisconsin transplant database was queried for adult kidney transplants from 1994-2014. Induction agents were divided into 3 groups: anti-thymocyte globulin (ATG), IL-2 receptor blockade (IL-2rB – basiliximab and daclizumab), or cell type specific depletion (CTSD – alemtuzumab, OKT3, and rituximab). The development of post-transplant malignancy was assessed using the Cox model and the Kaplan-Meier estimator. Log-rank test was used to compare survival rates among groups.

Results: From 1994-2014, 4,725 patients received kidney transplants with one of the three types of induction agents: ATG – 20%, IL-2rB – 56%, and CTSD – 24%. At 10y, the rate of malignancy development for all cancers was similar among groups: 22.9% for ATG, 20.9% for IL-2rB, and 22.1% for CTSD (p=0.29). The risk of non-EBV associated hematologic malignancies at 10y was 1% in all groups (p=0.91) while the 10y risk of skin cancer was 14.4% for the ATG and CTSD groups and 12.4% for IL-2rB group (p=0.16). There were no differences in viral associated malignancies with 10y rates of 2% for each group (p=0.24). The risk of solid organ tumors at 10y was 10.4% for ATG, 8.7% for IL-2rB and 8.2% for CTSD (p=0.88).

Conclusion: Despite their significant effects on the immune environment in the acute post-transplant phase, differences in induction agents do not appear to impact the development of post-transplant malignancies in this large cohort. Future analyses will characterize the interplay between induction agent, long-term immunosuppression regimens and additional patient outcomes after kidney transplantation.

CITATION INFORMATION: Livingston-Rosanoff D., Wang X., Leverson G., Kaufman D., Foley D. Induction Agents and Post-Transplant Malignancies in Kidney Transplants: An Examination of Outcomes at a Large Volume Center over 20 Years Am J Transplant. 2017;17 (suppl 3).

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