Effects of antibody induction on transplant outcomes in human leukocyte antigen zero-mismatch deceased donor kidney recipients

Hung Tien Kuo, Edmund Huang, Sina Emami, Phuong Thu Pham, Alan H. Wilkinson, Gabriel M. Danovitch, Suphamai Bunnapradist

Research output: Contribution to journalArticle

Abstract

BACKGROUND.: We aimed to investigate the impact of antibody induction on outcomes in human leukocyte antigen (HLA) 0-mismatched deceased donor kidney recipients. METHODS.: Using the Organ Procurement and Transplant Network/United Network of Organ Sharing database as of November 2009, we identified 44,008 adult deceased donor kidney recipients who received primary kidney transplants alone between 2003 and 2008 (HLA 0 mismatch, n=6274; ≥1 mismatch, n=37,734; median follow-up: 834 days). The impact of induction (thymoglobulin, interleukin-2 receptor antagonists [IL-2RA], or alemtuzumab; vs. no induction) on rejection (initial hospitalization, 6 months, first year), death-censored graft failure, and mortality were analyzed using multivariate logistic and Cox regression in the two groups. The impact of individual agents on outcomes was further analyzed in 0-mismatch recipients. RESULTS.: There was a decreased risk of rejection over the first 6 months for HLA 0-mismatch recipients of antibody induction (adjusted odds ratio=0.71, P=0.003), but this effect was not observed at 1 year; in comparison, induction was associated with a reduced risk of rejection over the first year for HLA-mismatched recipients (0.87, P<0.001). The use of thymoglobulin (0.72, P=0.02) and IL-2RA (0.67, P=0.004) was associated with a decreased risk of rejection compared with no-induction at 6 months but was not different at 1 year (thymoglobulin: 0.77, P=0.05; IL-2RA:0.81, P=0.11) in HLA 0-mismatched recipients. Induction was not associated with improved graft or patient survival in HLA 0-mismatch recipients. CONCLUSION.: In HLA 0-mismatch deceased donor recipients, antibody induction was associated with a decreased risk of rejection at 6 months posttransplant. Its use did not improve graft and patient survival over the follow-up period.

Original languageEnglish (US)
Pages (from-to)493-502
Number of pages10
JournalTransplantation
Volume93
Issue number5
DOIs
StatePublished - Mar 15 2012

Keywords

  • Induction
  • Kidney transplant
  • Outcomes
  • Zero HLA mismatch

ASJC Scopus subject areas

  • Transplantation

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    Kuo, H. T., Huang, E., Emami, S., Pham, P. T., Wilkinson, A. H., Danovitch, G. M., & Bunnapradist, S. (2012). Effects of antibody induction on transplant outcomes in human leukocyte antigen zero-mismatch deceased donor kidney recipients. Transplantation, 93(5), 493-502. https://doi.org/10.1097/TP.0b013e3182427fc3