Background: There has been an increase in the number of older (over 65) KT recipients. Aging-related changes such as differences in immune senescence may influence the impact of induction immunosuppression. There are no treatment guidelines for induction agent use, especially in highly vulnerable older KT. The goal of this study was to evaluate if the impact of various induction agents was different in older versus younger recipients, i.e. if guidelines for younger recipients applied to older ones.

Method: Using SRTR data, we identified 49,298 adult deceased donor KT recipients (2005-2013) who received IL2-RA or ATG induction [10,777 older recipients (>=65 years) and 38,521 younger recipients (18-64 years)]. High-risk was defined as any of the following: repeat KT, PRA>20%, HIV+, HCV+, CIT>24h, African American. Logistic regression models were used for delayed graft function (DGF) and one-year acute rejection. Cox proportional hazard models were used for mortality and death-censored graft loss.

Results: 63.1% of older and 70.2% of younger KT recipients received ATG. Among high-risk older recipients, ATG use was associated with a 0.62-fold(95%CI:0.50-0.78) decreased odds of one-year acute rejection, and a 0.84-fold(95%CI:0.75-0.94) decreased risk of mortality as compared to IL2-RA . Among high-risk younger recipients, ATG use was associated with a 0.74-fold(95%CI:0.67-0.83) decreased odds of one-year acute rejection, and a 0.86-fold(95%CI:0.78-0.94) decreased risk of mortality as compared to IL2-RA. Among low-risk older and younger recipients, ATG use was associated with an increased risk of DGF but not different in long-term survival as compared to IL2-RA.

Conclusion: For all high-risk KT recipients regardless of age, ATG was associated with decreased risk of mortality and decreased odds of one-year acute rejection. For all low-risk KT recipients regardless of age, ATG was not associated with a significant difference in long-term outcome. These findings suggest that recommendations for younger patients apply to older patients as well, regardless of concerns regarding immune senescence and differential risk in the elderly.

CITATION INFORMATION: Huang Q, Ammary F, McAdams-DeMarco M, Segev D. Understanding the Role of Induction Agents in Older versus Younger Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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