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Outcomes of Induction with T Lymphocyte-Depleting and IL-2 Receptor Blocking (IL-2RB) Antibodies in the Non-Broadly Sensitized Adult Deceased-Donor Kidney Transplant Recipients: Analysis in the Context of the CPRA Allocation System

A. H. Santos Jr1, Y. Li2, K. Alquadan1, M. Leghrouz1, X. Wen3

1Div. of Nephrology, Univ. of Florida, Gainesville, FL, 2Univ. of Florida, Gainesville, FL, 3Univ. of Rhode Island, Kingston, RI

Meeting: 2020 American Transplant Congress

Abstract number: B-001

Keywords: Antilymphocyte antibodies, Induction therapy, Kidney transplantation, Simulect

Session Information

Date: Saturday, May 30, 2020

Session Name: Poster Session B: Kidney Immunosuppression: Induction Therapy

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

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*Purpose: We studied outcomes of induction in non-broadly-sensitized adult deceased-donor kidney transplant recipients(DD-KTRs) in the context of the calculated panel reactive antibody (CPRA) allocation system.

*Methods: Using 1/2007-12/2017 SRTR data, we compared outcomes of induction with anti-thymocyte globulin (ATG), alemtuzumab (ALM), and interleukin-2 blockers (IL-2RB) in adult-DD-KTRs with CPRA below 80% (categorized into 0-9% and 10-79%) & maintained on calcineurin-inhibitor+mycophenolate+/- steroids. After propensity score matching of induction subgroups, multivariable regression analyses were conducted.

*Results: T-LYMPHOCYTE-DEPLETING (TLD) VS. IL-2RB INDUCTION: In the 0-9% CPRA group, compared with IL-2RB; 1) ATG or ALM has lower odds of 1-year biopsy-proven acute rejection (BPAR) and higher odds of hospitalization, 2) ATG has higher odds of delayed graft function (DGF), and 3) ALM has a higher and ATG has a lower risk of 5-year overall and death-censored graft loss (OAGL and DCGL, respectively), [Fig. 1]. In the 10-79% CPRA group, compared with IL-2RB, ATG or ALM has lower odds of 1-year BPAR and higher odds of DGF [Fig. 2]. TLD INDUCTION COMPARISONS: Compared with ALM; ATG has: 1) lower odds of 1-year hospitalization in the 0-9% CPRA stratum, but 2) similar odds of 1-year BPAR, 3) higher odds of DGF, and 4) lower risks of 5-year OAGL and DCGL in both CPRA strata, [Fig. 3].

*Conclusions: In non-broadly-sensitized adult-DD-KTRs, TLD provides BPAR protection with higher DGF and/or hospitalization risk(s) than IL-2RB induction. ATG may lower graft loss risk than IL-2RB and/or ALM induction(s) depending on the CPRA stratum(a).

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To cite this abstract in AMA style:

Jr AHSantos, Li Y, Alquadan K, Leghrouz M, Wen X. Outcomes of Induction with T Lymphocyte-Depleting and IL-2 Receptor Blocking (IL-2RB) Antibodies in the Non-Broadly Sensitized Adult Deceased-Donor Kidney Transplant Recipients: Analysis in the Context of the CPRA Allocation System [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-induction-with-t-lymphocyte-depleting-and-il-2-receptor-blocking-il-2rb-antibodies-in-the-non-broadly-sensitized-adult-deceased-donor-kidney-transplant-recipients-analysis-in-the-contex/. Accessed January 18, 2021.

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