Preemptive Second Kidney Transplant Outcomes by Induction Type in the United States

Samy Riad, Kurtis J. Swanson, Rasha El-Rifai, Gregory Larrieux, Logan Gylten, Scott Jackson, Raja Kandaswamy

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1 Scopus citations

Abstract

Background: The role of induction in preemptive second kidney recipients is unclear. We examined the association between induction therapy and the long-term graft and recipient survival in the settings of tacrolimus and mycophenolate maintenance. Methods: We identified all preemptive second kidney transplant recipients between 2000 and 2020 in the Scientific Registry of Transplant Recipients. We excluded those with missing or mixed induction regimens and positive crossmatch. We grouped recipients by induction type into 3 groups: anti-thymocyte globulin (n = 1442), alemtuzumab (n = 362), and interleukin-2 receptor antagonist (IL-2RA; n = 481). We generated Kaplan-Meier curves of the recipient and death-censored graft survival (DCGS) with follow-up censored at 10 years. We used multivariable Cox proportional hazards models to examine the association between induction and the above outcomes. We adjusted the models for recipient and donor variables. Results: Rates of delayed graft function, rejection, hospitalization, and post-transplant lymphoproliferative disorder at one year were not statistically different. Recipient survival did not vary by induction type in the Kaplan-Meier analysis (log-rank P =.189) or in the multivariable model. However, DCGS was the lowest in the Alemtuzumab group (log-rank P =.01). In the multivariable models, alemtuzumab was associated with a 57% increased risk of graft loss (1.57, 95% confidence interval (1.08, 2.30), P =.019) compared to anti-thymocyte. Live-donor kidneys were associated with significantly better recipient survival and DCGS. Conclusions: Compared to anti-thymocyte induction, alemtuzumab, but not IL-2RA, was associated with inferior graft survival in preemptive second transplant recipients discharged on tacrolimus and mycophenolate.

Original languageEnglish (US)
Pages (from-to)2125-2132
Number of pages8
JournalTransplantation proceedings
Volume54
Issue number8
DOIs
StatePublished - Oct 2022

Bibliographical note

Funding Information:
We want to acknowledge both the University of Minnesota department of medicine for providing the funds to acquire the SRTR SAF and the Fairview Health Services for providing the statistical support needed for this project.

Funding Information:
We want to acknowledge both the University of Minnesota department of medicine for providing the funds to acquire the SRTR SAF and the Fairview Health Services for providing the statistical support needed for this project. Special thanks to Stephanie Taylor, a Program/Project Specialist in the Division of Transplantation, for her assistance preparing this manuscript. Disclaimer: The data reported here have been supplied by the Hennepin Health care Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. Author Contributions: Samy M. Riad: concept/design, data interpretation, article drafting, critical revision of article, and approval of article. Kurtis J. Swanson: data interpretation, article drafting, critical revision of article, and approval of article. Rasha El-Rifai: data interpretation, article drafting, critical revision of article, and approval of article. Gregory Larrieux: concept/design, data interpretation, critical revision of article, and approval of article. Logan Gylten: drafting, critical revision, and approval of article. Scott Jackson: data analysis/interpretation, critical revision of article, and approval of article. Raja Kandaswamy: critical revision of article, and approval of article.

Publisher Copyright:
© 2022 Elsevier Inc.

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