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 July 7, 2020.
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