Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: In kidney transplantation, donor-recipient HLA-DR mismatch signals high immunologic risk and can result in poor transplant outcomes. Older kidney transplant recipients (KTRs) are more prone to the adverse consequences of immunosuppression. It is unclear whether a more robust immunosuppression with depleting compared to non-depleting antibody induction in older KTRs with HLA-DR mismatches translates into favorable post-transplant outcomes.
*Methods: Using OPTN/UNOS database, we identified KTRs > 65 years old who underwent transplantation from 2001-2015 and received either depleting (Thymoglobulin or alemtuzumab) or non-depleting (basiliximab or daclizumab) antibody induction followed by calcineurine inhibitor/mycophenolic acid maintenance with or without steroids. Patients were subsequently stratified by the number of donor-recipient HLA-DR mismatches (0, 1, 2) in both living donor (LD) and deceased donor(DD) kidney recipients. Graft and patient outcomes were compared for depleting vs. non-depleting induction under each HLA-DR mismatch category among both LD and DD kidney recipients using a Cox model that adjusted for donor, recipient and transplant variables.
*Results: Results are shown in table 1. Adjusted overall and death-censored graft survivals were similar between the induction types under each HLA-DR mismatch categories among LD and DD kidney transplant recipients. . However, adjusted patient survival was significantly higher in the depleting induction group among LD kidney recipients and trended superior in DD kidney recipients where there were 2 HLA-DR mismatches.
|Living donor transplant||Deceased donor transplant|
|Number of HLA-DR mismatches||0||1||2||0||1||2|
|Depleting induction (n)||287||1231||506||1341||2784||2575|
|Overall graft survival (HR with 95% CI)||0.71 (0.48-1.05)||0.95(0.77-1.16)||1.32 (0.97-1.80)||1.1(0.94-1.29)||0.98(0.88-1.11)||1.11(0.98-1.25)|
|Death-censored graft survival (HR with 95% CI)||0.59(0.24-1.50)||1.06(0.70-1.59)||1.28(0.72-2.26)||1.14(0.84-1.56)||0.99(0.81-1.21)||1.03(0.58-1.83)|
|Patient survival (HR with 95% CI)||0.87(0.60-1.27)||0.95(0.77-1.15)||1.40(1.08-2.02)*||1.06(0.90-1.25)||0.97(0.86-1.10)||1.13(0.99-1.27)**|
|p-value; *=0.02, **=0.05|
*Conclusions: Our study supports the use of depleting antibody induction in older KTRs with 2 HLA-DR mismatches. Survival benefits associated with depleting induction in these older but high immune risk patients could be related to more robust suppression of ongoing immunological injury and microvascular inflammation resulting in better long-term allograft function which is a marker for improved patient survival.
To cite this abstract in AMA style:Sureshkumar KK, Thai NL, Chopra B. Kidney Transplantation in Older Recipients with HLA-DR Mismatch: Impact of Induction Type on Outcomes [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/kidney-transplantation-in-older-recipients-with-hla-dr-mismatch-impact-of-induction-type-on-outcomes/. Accessed August 18, 2019.
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