The impact of selection of induction immunosuppression agent on incidence of delayed graft function (DGF) remains unclear. A total of 1,980 deceased donor kidney transplant recipients between 2000-2012 were divided into subgroups based on induction agent (Table 1). DGF was defined as use of dialysis within 7 days following transplantation. Basiliximab was utilized in 52.7% of the kidney transplants, while rabbit antithymocyte globulin (ATG, Thymoglobulin) was utilized in 13.7%. Fourteen patients were converted from basiliximab to ATG. The pre-transplant DGF risk (Irish et al, AJT 2010) was higher for patients receiving ATG than those receiving basiliximab (p<0.001) and similar to those converted from basiliximab to ATG (p=0.87). However, basiliximab was associated with a lower risk of DGF in propensity score-stratified models adjusted for pre-transplant DGF risk score (Table 2). Furthermore, conversion from basiliximab to ATG was not associated with a lower incidence of DGF.

These studies suggest that IL-2R inhibition may be associated with a lower incidence of DGF than ATG induction. However, randomized controlled trials are needed to specifically address the ideal induction therapy for the prevention of DGF.

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