Background: We studied the association of induction immunosuppression and pediatric deceased-donor kidney recipient and graft survival. Methods: We utilized the SRTR to evaluate all primary pediatric deceased-donor kidney transplants from January 1st, 2000, through December 2018. We included only recipients who were maintained on tacrolimus and mycophenolate. Recipients were grouped by induction type: alemtuzumab n = 320, r-ATG n = 2091 and IL-2RA n = 2165. Recipient and allograft survival, and their predictors, were examined. Models were adjusted for age, sex, ethnicity, HLA-antigen mismatches, transplant year, steroid maintenance, pre-emptive transplantation and payor type, with the transplant center included as a random effect. Results: Rejection rates at 6 months (alemtuzumab 8.6% vs r-ATG 7.8% vs IL2-RA 9.2%; P =.30) and 12 months (alemtuzumab 17.2% vs r-ATG 15.7% vs IL2-RA 16.5%; P =.70) were not significantly different between induction groups. In the multivariable models, compared to IL-2RA neither alemtuzumab nor r-ATG was associated with improved recipient [alemtuzumab (HR 1.06, P =.88); r-ATG (HR 1.03, P =.84)] or graft survival [alemtuzumab (HR 1.18, P =.32); r-ATG (HR 1.10, P =.21)]. Conclusion: In this large cohort of standard immunological risk primary pediatric deceased-donor kidney recipients on tacrolimus and mycophenolate maintenance, depletional induction regimens were not associated with better rejection rates, recipient, or graft survival compared to IL-2RA induction. Racial, payor type, and sex-related outcome disparities were significant in this group independent of the induction choice.
Bibliographical noteFunding Information:
We want to acknowledge both the University of Minnesota department of medicine for providing the funds to acquire the SRTR standard analysis file and the Fairview Health Services for providing the statistical support needed for this project. Special thanks to Stephanie Taylor, a project specialist at the division of surgery, for her editorial support.
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- deceased donor
- kidney transplant