Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: It is now common practice in the transplant community to select induction therapy on the basis of perceived immunological risk for acute rejection which commonly includes African american(AA) ethnicity, PRA>20%,and re-transplants. There is little data to support non depleting induction agents in black recipients of renal transplantation
*Methods: Study population is summarized using frequency and percentages..Unadjusted logistic regression models were used to identify the factors associated with graft outcome. Stepwise regression was carried out to obtain final adjusted model. Time to graft loss was modeled using Cox proportional hazard regression. The analysis was done using STATA 15.
*Results: This is a retrospective single center analysis of predominantly African American kidney transplant recipients n=244,followed over mean duration 49±24 mo. (1/2012-12/2018) for Biopsy proven acute rejection(BPAR),viral, bacterial, fungal infection, and graft loss compared between induction agents rATG and IL2RA.All recipients were maintained on calcineurin inhibitor based triple IS.There were 191 first kidney only transplant recipients of whom 39% received induction with rATG and 61% IL2RA .African Americans 91% vs. 9% other.Majority had EPTS > 20 (71%), peak PRA>50% (14%), KDPI >20 in (23%), CIT>24(17%), DCD (18%). African American recipients (n=173). Multivariate analysis, showed no difference in graft survival between induction agents rATG vs. IL2RA (21% vs.18.6%, p=.70). History of first BPAR was similar between groups rATG n=74(39%) and IL2RA n=117(61%) and not significant (16% vs.24%, p=0.27) respectively. when compared with IL2RA, induction with rATG increases the odds of having viral infections adjusted for being on dialysis ≥3 years vs <3 years and re- transplants; OR 2.53 (CI 1.2-5.2, p=0.014), Bacterial infections OR 2.72 ( CI 1.32-5.71, p= 0.006 ), any infection; OR 2.5 ( CI 1.2- 5.2 ,p=0.014). The cause of ESRD, DM or GN were independent risk factors for any infection post-transplant (P=0.005).
*Conclusions: In our single center analysis of predominantly AA renal transplant recipients, type of induction agent used did not demonstrate benefit for graft survival or rejection free survival. There was a significant risk for infection with rATG. Depleting therapy should be balanced against the risks of infection or malignancy in the context of a lack of long‐term data demonstrating a graft survival benefit with type of induction used. Risk stratification based on ethnicity status alone needs to be reconsidered and future research needed to determine the ideal induction agents for specific immunological risk.
To cite this abstract in AMA style:Zachariah M, Mallawaarachchi I, Meeks N, Wright D, Minawala R, Liu V, Rolls J, Hussein S, Jarrin C. Induction Therapy with Basiliximab versus Thymoglobulin in African-American Kidney Transplant Recipients in the Current Era of Immunosuppression [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/induction-therapy-with-basiliximab-versus-thymoglobulin-in-african-american-kidney-transplant-recipients-in-the-current-era-of-immunosuppression/. Accessed October 24, 2020.
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