Induction Therapy in Low Risk African American Kidney Transplant Recipients: Donor Factors.

F. Al Ammary,¹ S. Bae,¹ A. Massie,¹ N. Dagher,¹ E. King,¹ A. Wiseman,² D. Segev.¹

¹JHU, Baltimore
²CU, Denver.

Meeting: 2016 American Transplant Congress

Abstract number: C53

Keywords: African-American, Induction therapy, Kidney transplantation, Outcome

Session Information

Session Name: Poster Session C: Clinical Science - Kidney Immunosuppression: Induction Therapy

Session Type: Poster Session

Date: Monday, June 13, 2016

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

African Americans (AA) are at a higher risk of acute rejection and graft loss compared to non-AA kidney transplant (KT) recipients. Guidelines specify induction choices by recipient factors. However, the role of donor factors in this decision-making has not been explored, particularly in low-risk AA recipients. We aimed to compare outcomes of ATG versus IL2 in low-risk AA KT, stratified by KDPI.

METHODS: Using OPTN data, we identified 3870 low-risk AA (first-time, KT alone, 0% PRA, HIV-negative, HCV-negative, CIT<24h) deceased-donor KT recipients between 2003-2014 who received ATG or IL2 induction in addition to Tacrolimus (Tac), Mycophenolate (MPA), and steroid immunosuppression. We built Cox models for all-cause graft loss (ACGL), death-censored graft loss (DCGL), and mortality, as well as logistic regression models for acute rejection at 1 year (AR). Patients were stratified into 3 KDPI categories (low: 0-34, moderate: 35-85, high: 86+)

Table 1: KDPI Strata	ATG (N=2593)	IL2 (N=1277)
Low 0-34	32.2%	36.4%
Moderate 35-85	56.9%	53.6%
High 86-100	10.9%	9.9%

RESULTS: Compared to ATG, IL2 in low, moderate, and high-KDPI KT was not associated with a significant difference in ACGL (aHR=_0.811.03_1.30, p=0.7, _0.931.1_1.31, p=0.3, and _0.680.95_1.31, p=0.8); DCGL (aHR=_0.831.13_1.53, p=0.6, _1.001.26_1.58, p=0.04, and _0.540.86_1.37, p=0.5); or mortality (aHR=_0.741.01_1.39, p=1.0, _0.720.90_1.12, p=0.4, and _0.670.99_1.47, p=1.0). However, IL2 was associated with increased risk of AR in moderate-KDPI (aOR=_1.121.51_2.02,p=0.001) and a trend toward AR in high-KDPI (aOR= _0.651.27_2.5, p=0.5), but not in low-KDPI KT (aOR= _0.671.08_1.74,p=0.8) .

CONCLUSION: ATG was not associated with better outcomes compared to IL2 in the low-KDPI category when using Tac/MPA/prednisone in a low-risk AA KT population. These results suggest a low-KDPI should not influence choice of induction, while in moderate and high-KDPI, ATG would be the preferred choice in low-risk AA KT recipients.

CITATION INFORMATION: Al Ammary F, Bae S, Massie A, Dagher N, King E, Wiseman A, Segev D. Induction Therapy in Low Risk African American Kidney Transplant Recipients: Donor Factors. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Ammary FAl, Bae S, Massie A, Dagher N, King E, Wiseman A, Segev D. Induction Therapy in Low Risk African American Kidney Transplant Recipients: Donor Factors. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/induction-therapy-in-low-risk-african-american-kidney-transplant-recipients-donor-factors/. Accessed November 22, 2024.

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