No abstract

Introduction: Delayed graft function (DGF) after kidney transplant is associated with high risk of acute rejection (AR) and graft failure. The optimal immunosuppressive strategy for patients with DGF remains unknown. Material and method:We compare the 5-year outcomes of induction therapies with methylprednisolone (n = 58), basiliximab (n = 56) or alemtuzumab (n = 98) in patients with DGF. Maintenance was tacrolimus and mycophenolate with prednisone in methylprednisolone and basiliximab groups or without prednisone in alemtuzumab group. Protocol biopsies were performed in all patients.Results: 5-year biopsy-confirmed AR rates were significantly different among the 3 groups (39.7%, 28.6% and 20.4% in methylprednisolone, basiliximab and alemtuzumab group, respectively; p = 0.034). There was a trend of difference in Kaplan-Meier estimated 5-year graft survivals among the 3 groups (65.5%, 71.4% and 80.6%, respectively; log rank p = 0.07). Alemtuzumab group had a lowest incidence of AR and highest graft survival. The 5-year patient survivals were not statistically different in the 3 groups (75.9%, 82.1% and 84.7%, log rank p = 0.4). Multivariable analysis using methylprednisolone induction as control indicated that alemtuzumab (HR 0.36, 95% CI 0.13-0.85; p = 0.036) and basiliximab (HR 0.67, 95% CI 0.20-0.97; p = 0.023) were associated with lower risk of AR. Conclusion:Alemtuzumab induction decreases AR rate in kidney transplant patients with DGF and can improve longterm graft survival in comparison to other induction therapies.