Use and Outcomes of Induction Therapy in Well-Matched Kidney Transplant Recipients

Abstract

Background and objectivesThe optimal induction treatment in low–immune risk kidney transplant recipients is uncertain. We therefore investigated the use and outcomes of induction immunosuppression in a low-risk cohort of patients who were well matched with their donor at HLA-A, -B, -DR, -DQB1 on the basis of serologic typing.Design, setting, participants, & measurementsOur study was an observational study of first adult kidney-only transplant recipients in the United States recorded by the Organ Procurement and Transplant Network.ResultsAmong 2976 recipients, 57% were treated with T cell–depleting antibodies, 28% were treated with an IL-2 receptor antagonist, and 15% were treated without induction. There was no difference in allograft survival, death-censored graft survival, or death with function between patients treated with an IL-2 receptor antagonist and no induction therapy. In multivariable models, patients treated with T cell–depleting therapy had a similar risk of graft loss from any cause, including death (hazard ratio, 1.19; 95% confidence interval, 0.98 to 1.45), compared with patients treated with an IL-2 receptor antagonist or no induction. The findings were consistent in subgroup analyses of Black recipients, patients grouped by calculated panel reactive antibody, and donor source. The incidence of acute rejection at 1 year was low (≤5%) and did not vary between treatment groups.ConclusionsUse of induction therapy with T cell–depleting therapy or IL-2 receptor antagonists in first kidney transplant recipients who are well matched with their donor at the HLA-A, -B, -DR, -DQB1 gene loci is not associated with improved post-transplant outcomes.

Human Regulatory T Cells: Understanding the Role of Tregs in Select Autoimmune Skin Diseases and Post-Transplant Nonmelanoma Skin Cancers

“…Furthermore, many centers have incorporated IL-2 antagonists in post-transplant immunosuppressive regimens [ 221 ]. Still, the results are unclear as to whether the use of IL-2 receptor antagonists are associated with improved post-transplant outcomes [ 221 , 222 ]. For example, a meta-analysis by Ali et al, demonstrated that IL-2R antibody induction therapy did not improve the rate of rejection or graft survival for renal transplant recipients on tacrolimus maintenance therapy.…”

Prevalence of renal pathological disorders in kidney transplant recipients: an observational study in the north of Iran

“…Among these, transplant rejection is a big problem that always threatens kidney recipients (12,13). Therefore, to minimize these vital problems, the kidney recipient and donor should be thoroughly examined from an immunological point of view before the kidney transplant operation (14)(15)(16).…”

Induction Therapy in Immunologically Well-Matched Recipients

“…In this issue of CJASN , Evans et al (6) compared outcomes for well-matched recipients who received antibody induction with those of recipients who did not receive induction therapy. They used US Organ Procurement and Transplantation Network data and included adult recipients transplanted between 2010 and 2014.…”

“…Although the case for induction therapy in well-matched recipients is largely theoretical, the argument against its use has some evidence justification. In this context, the findings of Evans et al (6) highlight the need to risk-stratify patients and consider the balance between reducing the 5% short-term risk of rejection with induction therapy and reducing the long-term risk of infections and malignancies (and higher risk of death) by avoiding induction therapy. However, registry-based retrospective studies can only inform us so far.…”

“…Finally, it goes without saying that patient-reported outcomes should be considered as well. Until we can be better informed by clinically relevant trials, the important study by Evans et al (6) in this issue should make us consider whether we have pushed too far in our quest to avoid rejection in well-matched recipients and that there are indeed clinical settings when less may be more.…”