Outcomes after anti-thymocyte globulin vs Basiliximab induction before deceased donor kidney transplants.

Autor: Hafeez MS; The Aga Khan University - Medical College, The Aga Khan University, Karachi, Pakistan. Electronic address: saad.hafeez@alumni.aku.edu., Haq MU; The Aga Khan University - Medical College, The Aga Khan University, Karachi, Pakistan., Bakhthiyar SS; Department of Surgery, University of Colorado, Aurora, CO, United States of America., Azhar K; The Aga Khan University - Medical College, The Aga Khan University, Karachi, Pakistan., Awan AAY; Division of Nephrology and Abdominal Transplantation, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America., Ramana Murthy BV; Division of Nephrology and Abdominal Transplantation, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America., Abbas R; Division of Abdominal Transplantation, Department of Surgery, Baylor College of Medicine, Houston, TX, United States of America.
Jazyk: angličtina
Zdroj: Transplant immunology [Transpl Immunol] 2022 Dec; Vol. 75, pp. 101733. Date of Electronic Publication: 2022 Nov 05.
DOI: 10.1016/j.trim.2022.101733
Abstrakt: Background: Deceased donor kidney transplants represent an important source of renal replacement for the 100 000 patients initiating hemodialysis annually. We compared the association of induction therapy, anti-thymocyte globulin [rabbit] (rATG) or basiliximab, with posttransplant rejection, graft and patient survival.
Methods: Using the United Network for Organ Sharing (UNOS) database, we identified patients that received deceased donor kidney transplants. The outcomes analyzed were 6- month rejection, 1-year rejection, patient survival and graft survival. Multivariate logistic regression models were constructed to understand the association of induction therapy and rejection. Cox-proportional hazards models were constructed to ascertain the association of choice of induction therapy with both patient and graft survival.
Results: Of 45 339 patients, 33 906 patients received rATG induction therapy and 11 433 patients received basiliximab induction therapy. The rATG group were younger (53.44 years vs 55.28 years, P < 0.001), more frequently female (58.74% male vs 66.08%, P < 0.001) and more frequently Black (34.78% vs 25.66%, p < 0.001) compared with patients in the basiliximab group. Rejection was more likely with basiliximab compared with rATG at 6 months(OR = 1.64, P < 0.001; 7.81% Basiliximab vs 5.23% rATG)and at 12 months (OR = 1.56, P < 0.001; 8.81% Basiliximab vs 6.31% rATG). Basiliximab induction therapy was associated with worse patient survival, (HR = 1.05, P = 0.017). Basiliximab induction therapy was associated with worse graft survival, (HR = 1.03, P = 0.037).
Conclusion: The analysis of the national experience demonstrated favorable rejection, patient survival, and graft survival with rATG usage. Further prospective data are necessary to provide treatment recommendations.
Competing Interests: Declaration of Competing Interest The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
(Copyright © 2022 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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