Induction Type and Outcomes in HLA-DR Mismatch Kidney Transplantation
Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, PA.
Meeting: 2018 American Transplant Congress
Abstract number: B124
Keywords: HLA matching, Induction therapy
Session Information
Session Name: Poster Session B: Kidney Immunosuppression: Induction Therapy
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
In kidney transplantation, donor-recipient HLA-DR mismatch is considered high immunologic risk portending inferior outcomes. We sought to explore the impact of induction type used on kidney transplant outcomes at varying levels of donor-recipient HLA-DR mismatches. Using OPTN/UNOS database, we identified adult living donor kidney (LDK) and deceased donor kidney (DDK) transplant recipients from 2001 to 2015 discharged on calcineurine inhibitor/mycophenolic acid maintenance following either depleting (Thymoglobulin/alemtuzumab) or non-depleting (basiliximab/daclizumab) antibody induction. Patients were then stratified by the number of donor-recipient HLA-DR mismatches (0,1 or 2) in both LDK and DDK groups. Using a Cox model adjusting for donor, recipient and transplant variables, overall and death-censored graft failure risks along with patient death risk were compared for depleting vs. non-depleting induction under each HLA-DR mismatch categories. Results are shown in table 1.
Living donor transplant | Deceased donor transplant | |||||
Number of HLA-DR mismatches | 0 | 1 | 2 | 0 | 1 | 2 |
Depleting antibody induction (n) | 4409 | 13,558 | 7694 | 10,124 | 20,454 | 16,908 |
Non-depleting antibody induction (n) | 2536 | 6019 | 3033 | 3791 | 7540 | 6105 |
Adjusted overall graft failure risk (HR with 95% CI) | 1.06 (0.93-1.20) | 1.02(0.95-1.10) | 0.93 (0.84-1.03) | 0.97 (0.89-1.04) | 0.96 (0.92-1.01) | 0.93 (0.89-0.99)** |
Adjusted death-censored graft failure risk (HR with 95% CI) | 1.05 (0.88-1.26) | 0.99 (0.90-1.09) | 0.97 (0.85-1.10) | 0.97 (0.87-1.09) | 0.99 (0.92-1.06) | 0.97 (0.90-1.05) |
Adjusted patient death risk (HR with 95% CI) | 1.08 (0.92-1.25) | 1.04 (0.95-1.13) | 0.88 (0.78-1.0)* | 0.95 (0.88-1.04) | 0.97 (0.91-1.03) | 0.90 (0.85-0.96)*** |
p-value: *=0.05; **=0.02; ***=0.001 |
Our study showed significantly lower adjusted patient death risk associated with depleting vs. non-depleting peri-operative induction among DDK recipients and a trend towards the same in LDK recipients within the higher immune risk donor-recipient 2 HLA-DR allele mismatch categories. This survival benefit associated with depleting induction could likely be related to more robust suppression of ongoing immunological injury with better long-term allograft function, an observation more pronounced in DDK transplantation.
CITATION INFORMATION: Sureshkumar K., Hussain S., Chopra B. Induction Type and Outcomes in HLA-DR Mismatch Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Sureshkumar K, Hussain S, Chopra B. Induction Type and Outcomes in HLA-DR Mismatch Kidney Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/induction-type-and-outcomes-in-hla-dr-mismatch-kidney-transplantation/. Accessed October 15, 2024.« Back to 2018 American Transplant Congress