Controversy exists regarding the optimal choice of induction therapy in low-risk kidney transplant (KT) recipients. Current guidelines specify induction choices in KT based on recipient factors and would recommend IL2 receptor antagonists over ATG in low-risk patients. However, the impact of donor factors in this decision-making remains unclear. We aimed to compare outcomes of ATG versus IL-2 receptor antagonists in low-risk KT, stratified by Kidney Donor Profile Index (KDPI).

METHODS: Using OPTN data, we identified 14,172 low-risk (first-time, KT alone, non-African American, PRA<20%, 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+)

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RESULTS: Compared to ATG, IL2 in low, moderate, and high-KDPI KT was not associated with a difference in ACGL (aHR=_0.850.98_1.11, p=0.7, _0.890.98_1.07, p=0.6, and_0.740.89_1.07, p=0.2), DCGL (aHR=_0.770.95_1.17, p=0.6, _0.891.03_1.20, p=0.6,and_0.690.92_1.23, p=0.6), or mortality (aHR=_0.840.98_1.15, p=0.8, _0.840.93_1.04, p=0.2, and_0.740.90_1.10, p=0.3). However, IL2 was associated with increased risk of AR in moderate-KDPI KT (aOR= _1.061.26_1.56, p=0.01) and high-KDPI KT (aOR= _1.161.64_2.32, p=0.01), but not low-KDPI KT (aOR= _0.740.96_1.30, p=0.76) .

CONCLUSION: ATG was not associated with superior long-term benefits compared to IL2 within all KDPI strata when using Tac/MPA/prednisone in a low-risk KT population, while the risk of AR was similar in the low-KDPI category. These results suggest that KDPI can be used to guide selecting the optimal induction therapy in otherwise low-risk KT recipients.

CITATION INFORMATION: Al Ammary F, Bae S, Massie A, Desai N, Dagher N, Kraus E, Wiseman A, Segev D. Long-Term Outcomes of ATG versus IL-2 Receptor Antagonist in Low Risk Kidney Transplant Recipients: Donor Factors. Am J Transplant. 2016;16 (suppl 3).

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