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A comparison of three induction therapies on patients with delayed graft function after kidney transplantation

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Abstract

We compare the outcomes of induction therapies with either methylprednisolone (group 1, n = 58), basiliximab (group 2, n = 56) or alemtuzumab (group 3, n = 98) in primary deceased donor kidney transplants with delayed graft function (DGF). Protocol biopsies were performed. Maintenance was tacrolimus and mycophenolate with steroid (group 1 and 2) or without steroid (group 3). One-year biopsy-confirmed acute rejection (AR) rates were 27.6, 19.6 and 10.2 % in group 1, 2 and 3 (p = 0.007). AR was significantly lower in group 3 (p = 0.002) and group 2 (p = 0.03) than in group 1. One-year graft survival rates were 90, 96 and 100 % in group 1, 2 and 3 (log rank p = 0.006). Group 1 had inferior graft survival than group 2 (p = 0.03) and group 3 (p = 0.002). The patient survival rates were not different (96.6, 98.2 and 100 %, log rank p = 0.81). Multivariable analysis using methylprednisolone induction as control indicated that alemtuzumab (OR 0.31, 95 % CI 0.11–0.82; p = 0.03) and basiliximab (OR 0.60, 95 % CI 0.23–0.98; p = 0.018) were associated with lower risk of AR. Therefore, alemtuzumab or basiliximab induction decreases AR and improves graft survival than methylprednisolone alone in patients with DGF. Alemtuzumab induction might also allow patients with DGF to be maintained with contemporary steroid-withdrawal protocol.

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Acknowledgments

We thank the members of Tulane Transplant Institute for maintaining the transplant data base.

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Authors and Affiliations

  1. Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, USA

    Afia Umber, Muhammad Atiq, Belinda Lee, Arnold Brent Alper, Eric Simon & Rubin Zhang

  2. Department of Surgery, Tulane University School of Medicine, New Orleans, LA, 70112, USA

    Mary Killackey, Anil Paramesh & Joseph Buell

  3. Department of Biostatistics, Tulane University School of Public Health and Tropic Medicine, New Orleans, LA, USA

    Yongjun Liu & Huaizhen Qin

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  1. Afia Umber
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  2. Mary Killackey
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  3. Anil Paramesh
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  4. Yongjun Liu
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  5. Huaizhen Qin
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  6. Muhammad Atiq
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  7. Belinda Lee
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  8. Arnold Brent Alper
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  9. Eric Simon
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  11. Rubin Zhang
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Correspondence to Rubin Zhang.

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The authors declare that they have no conflict of interest.

Human rights statement

This study was approved by the Institutional Review Board (IRB) of Tulane University.

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Informed consent from individual participant is not indicated as it is a retrospective analysis and there is no identifying information about any participant in the article.

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Umber, A., Killackey, M., Paramesh, A. et al. A comparison of three induction therapies on patients with delayed graft function after kidney transplantation. J Nephrol 30, 289–295 (2017). https://doi.org/10.1007/s40620-016-0304-7

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  • DOI: https://doi.org/10.1007/s40620-016-0304-7

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