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Outcomes based on induction regimens in pediatric kidney transplantation: a NAPRTCS and PHIS collaborative study

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A Correction to this article was published on 03 July 2023

This article has been updated

Abstract

Background

Induction agent used at the time of kidney transplant is often based upon center practice and recipient characteristics. We evaluated outcomes across induction therapies among children enrolled in the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) transplant registry with data in the Pediatric Health Information System (PHIS).

Methods

This is a retrospective study of merged data from NAPRTCS and PHIS. Participants were grouped by induction agent: interleukin-2 receptor blocker (IL-2 RB), anti-thymocyte/anti-lymphocyte globulin (ATG/ALG), and alemtuzumab. Outcomes assessed included 1-, 3-, and 5-year allograft function and survival, rejection, viral infections, malignancy, and death.

Results

A total of 830 children transplanted between 2010 and 2019. At 1 year post-transplant, the alemtuzumab group had higher median eGFR (86 ml/min/1.73 m2) compared to IL-2 RB and ATG/ALG (79 and 75 ml/min/1.73 m2, respectively; P < 0.001); at 3 and 5 years, there was no difference. Adjusted eGFR over time was similar across all induction agents. Rejection rates were lower among the alemtuzumab group vs. IL-2RB and ATG (13.9% vs. 27.3% and 24.6%, respectively; P = 0.006). Adjusted ATG/ALG and alemtuzumab had higher hazard ratio for time to graft failure compared to IL-2 RB (HR 2.48 and HR 2.11, respectively; P < 0.05). Incidence of malignancy, mortality, and time to first viral infection was similar.

Conclusion

Although rejection and allograft loss rates were distinct, the incidences of viral infection and malignancy were comparable across induction agents. By 3 years post-transplant, there was no difference in eGFR.

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Data Availability

Dataset is available upon request from authors and registry approval.

Change history

Abbreviations

ALG:

Anti-lymphocyte globulin

ATG:

Anti-thymocyte globulin

BK:

BK polyoma virus

CMV:

Cytomegalovirus

CPT:

Current procedural terminology

EBV:

Epstein-Barr virus

eGFR:

Estimated glomerular filtration rate

HLA:

Human leukocyte antigen

HR:

Hazard ratio

ICD:

International classification of diseases

IL-2 RB:

Interleukin-2 receptor blocker

IQR:

Interquartile range

NAPRTCS:

North American Pediatric Renal Trials and Collaborative Studies

OPTN:

Organ Procurement Transplant Network

PHIS:

Pediatric Health Information Systems

PTLD:

Post-transplant lymphoproliferative disorder

SRTR:

Scientific Registry of Transplant Recipients

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Acknowledgements

We would like to acknowledge the NAPRTCS study group and participants for making this research possible.

Funding

The study was funded through the Ancillary study grant program of NAPRTCS.

Author information

Author notes

  1. Daniella Levy Erez and Helen Pizzo contributed equally to this work.

Authors and Affiliations

  1. Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Daniella Levy Erez

  2. Schneider Children’s Medical Center, Petach Tiqva, Israel

    Daniella Levy Erez

  3. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Helen Pizzo

  4. Boston Children’s Hospital, Boston, MA, USA

    Nancy Rodig & Michael Somers

  5. Children’s Hospital Association, Lenexa, KS, USA

    Troy Richardson

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  1. Daniella Levy Erez
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Correspondence to Daniella Levy Erez.

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The original online version of this article was revised: Affiliation 2 was corrected and the word alemtuzumab was replaced with IL-2 RB in the Results section.

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Erez, D.L., Pizzo, H., Rodig, N. et al. Outcomes based on induction regimens in pediatric kidney transplantation: a NAPRTCS and PHIS collaborative study. Pediatr Nephrol 38, 3455–3464 (2023). https://doi.org/10.1007/s00467-023-05955-5

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  • DOI: https://doi.org/10.1007/s00467-023-05955-5

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