Impact of Induction Therapy on Clinical Outcomes of Kidney Transplant Recipients: A Single-Centre Cohort Study
Main Article Content
Keywords
immunosuppressive therapy, induction therapy, initial graft function, long-term graft function, transplantation
Abstract
The purpose of this study was to evaluate long-term efficacy of immunosuppressive drugs based on the type of induction therapy given to kidney transplant recipients, and determine the occurrence of graft dysfunctions or rejections. We compared the safety and efficacy of anti-thymocyte globulin (ATG) and basiliximab (BAS) in high-risk patients and analyzed the cumulative incidence of immediate, slow, and delayed graft function in kidney transplant recipients to determine their initial short-term graft function. Evaluation of the long-term efficacy after 3 years post-transplantation by assessment of patients and graft survival, incidence of infections, and risks of rejection were the primary endpoints. Patients with stable graft survival were observed more with ATG (85%) than BAS (70%); in contrast, graft dysfunctions, graft nephrectomy, rejection episodes, and patient deaths were more prevalent with BAS than ATG, with statistically significant differences in long-term graft functioning. Patient survival at 3 years in ATG group was 90.4%, compared to 88% in BAS group, and graft survival was 90.4% in the ATG group and 81.3% in the BAS group (P < 0.001). The use of both induction therapies resulted in good patient and graft survival outcomes than placebo, and the results showed that there was a significant difference in both patient and graft survival after 3 years between induction of ATG and BAS, suggesting that ATG can be safer, effective, and preferable drug over BAS for high-risk recipients.
References
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11. Rao C, Haifeng W, Lei S, Jianfei H, Jiawei P, Helong D et al. Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation. BMC Nephrol. 2020;21:526. 10.1186/s12882-020-02181-1
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14. Sailaja K, Purna P, Uma MR, Srinivasa MAR, Sahariah S. Anti-thymocyte globulin versus basiliximab induction in renal transplant recipients: Long-term outcome. Saudi J Kidney Dis Transpl. 2014;25:9–15. 10.4103/1319-2442.124459
15. Seong UC, Ju IM, Seok C, Se HY, Won MH, Sung RY. Comparison of the clinical outcomes between anti-thymocyte globulin and basiliximab induction therapy in deceased donor kidney transplantation: Single center experience. J Korean Soc Transplant. 2015;29:61–7. 10.4285/jkstn.2015.29.2.61
16. Patlolla V, Zhong X, Reed GW, Mandelbrot DA. Efficacy of anti-IL-2 receptor antibodies compared to no induction and to antilymphocyte antibodies in renal transplantation. Am J Transplant. 2007;7(7):1832–42. 10.1111/j.1600-6143.2007.01860.x
17. Boucquemont J, Foucher Y, Masset C, Legendre C, Scemla A, Buron F, et al. Induction therapy in kidney transplant recipients: Description of the practices according to the calendar period from the French multicentric DIVAT cohort. PLoS One. 2020;15(10):e0240929. 10.1371/journal.pone.0240929
18. Cristina D, Ramón C, Mireia C, Elizabeth P, Jose LL, Concepcion GG, et al. Low total dose of anti-human T-lymphocyte globulin (ATG) guarantees a good glomerular filtration rate after liver transplant in recipients with pretransplant renal dysfunction. Can J Gastroenterol Hepatol. 2018;2018:1672621. 10.1155/2018/1672621
19. Song T, Yin S, Li X, Jiang Y, Lin T. Thymoglobulin vs. ATG-Fresenius as induction therapy in kidney transplantation: A Bayesian network meta-analysis of randomized controlled trials. Front. Immunol. 2020;11:457. 10.3389/fimmu.2020.00457
20. Ko H, Min S, Han A, Mo H, Chung CTY, Kim HK, et al. Inferior outcomes of basiliximab compared to anti-thymocyte globulin induction therapy in kidney transplantation with weak pretransplant donor specific anti-hla antibody. Transplantation. 2020;104(3):366. 10.1097/01.tp.0000700404.96761.a6
21. Christophe M, Julie B, Claire G, Fanny B, Emmanuel M, Sophie G, et al. Induction therapy in elderly kidney transplant recipients with low immunological risk. Transplantation. 2020;104(3):613–22. 10.1097/TP.0000000000002804
22. Sang JK, Jinsoo R, Heejin Y, Kyunga K, Kyo WL, Jae BP. Outcome comparison between low-dose rabbit anti-thymocyte globulin and basiliximab in low-risk living donor kidney transplantation. J Clin Med. 2020;9(5):1320. 10.3390/jcm9051320
23. Lee H, Lee S, Jeon JS, Kwon SH, Noh H, Han DC, et al. Thymoglobulin versus basiliximab induction therapy in low-risk kidney transplant recipients: A single-center experience. Transplant. Proc. 2018;50:1285–8. 10.1016/j.transproceed.2018.02.088
24. Hannah K, Marta J, Mathieu H, Benjamin T, Ludovic DA, Pierre P, et al. Different impact of rATG induction on CMV infection risk in D+R-and R+ KTRs. J Infect Dis. 2019;220(5):761–71. 10.1093/infdis/jiz194
25. Marta J, Edoardo M, Elena C, Anna M, Nuria M, Joan T, et al. CMV-specific cell-mediated immunity at 3-month prophylaxis withdrawal discriminates D+/R+ kidney transplants at risk of late-onset CMV Infection regardless the type of induction therapy. Transplantation. 2018;102(11):e472–e480. 10.1097/TP.0000000000002421
2. National Kidney Foundation. New options in maintenance immunosuppression: A clinical update on managing kidney transplant recipients. New York, NY: National Kidney Foundation; 2015.
3. Phanish MK, Hull RP, Andrews PA, Popoola J, Kingdon EJ, MacPhee IAM et al. Immunological risk stratification and tailored minimisation of immunosuppression in renal transplant recipients. BMC Nephrol. 2020;21(1):92. 10.1186/s12882-020-01739-3
4. Marcus FL, Rodrigo SD, José AN, Raquel AF, Raquel GS, Evaldo N. Effects of immunotherapy induction on outcome and graft survival of kidney-transplanted patients with different immunological risk of rejection. BMC Nephrol. 2019;20(1):314. 10.1186/s12882-019-1497-5
5. Boucquemont J, Foucher Y, Masset C, Legendre C, Scemla A, Buron F et al. Induction therapy in kidney transplant recipients: Description of the practices according to the calendar period from the French multicentric DIVAT cohort. PLoS One. 2020;15(10):e0240929. 10.1371/journal.pone.0240929
6. Rita RA, Woodle ES, Abramowicz D, Dorry L, Castan R, Jilian NI et al. Rabbit anti-thymocyte globulin for the prevention of acute rejection in kidney transplantation. Am J Transplant. 2019;19:2252–61. 10.1111/ajt.15342
7. Maurizio S, Aris T. Immunosuppression in kidney transplantation. OBM Transplant. 2020:4(1):97. 10.21926/obm.transplant.2001097
8. Hellemans R, Bosmans JL, Abramowicz D. Induction therapy for kidney transplant recipients: Do we still need anti-IL2 receptor monoclonal antibodies? Am J Transplant. 2017;17:22–7. 10.1111/ajt.13884
9. Helfer MS, Pompeo JC, Costa ORS, Vicari AR, Ribeiro AR, Manfro RC. Long-term effects of delayed graft function duration on function and survival of deceased donor kidney transplants. Braz J Nephrol. 2019;41(2):231–41. 10.1590/2175-8239-jbn-2018-0065
10. Bayraktar A, Catma Y, Akyildiz A, Demir E, Bakkaloglu H, Ucar AR, et al. Infectious complications of induction therapies in kidney transplantation. Ann Transplant. 2019;24:412–7. 10.12659/AOT.915885
11. Rao C, Haifeng W, Lei S, Jianfei H, Jiawei P, Helong D et al. Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation. BMC Nephrol. 2020;21:526. 10.1186/s12882-020-02181-1
12. Sandrini S. Use of IL-2 receptor antagonists to reduce delayed graft function following renal transplantation: A review. Clin Transplant. 2005;19:705–10. 10.1111/j.1399-0012.2005.00417.x
13. Szczepanik A, Burrelli C, Bixby A, Yadav K, Chavin K. Basiliximab vs. antithymocyte globulin induction with early steroid withdrawal in kidney transplant recipients: Early rejection outcomes. Am J Transplant. 2020. https://atcmeetingabstracts.com/abstract/basiliximab-vs-antithymocyte-globulin-induction-with-early-steroid-withdrawal-in-kidney-transplant-recipients-early-rejection-outcomes/
14. Sailaja K, Purna P, Uma MR, Srinivasa MAR, Sahariah S. Anti-thymocyte globulin versus basiliximab induction in renal transplant recipients: Long-term outcome. Saudi J Kidney Dis Transpl. 2014;25:9–15. 10.4103/1319-2442.124459
15. Seong UC, Ju IM, Seok C, Se HY, Won MH, Sung RY. Comparison of the clinical outcomes between anti-thymocyte globulin and basiliximab induction therapy in deceased donor kidney transplantation: Single center experience. J Korean Soc Transplant. 2015;29:61–7. 10.4285/jkstn.2015.29.2.61
16. Patlolla V, Zhong X, Reed GW, Mandelbrot DA. Efficacy of anti-IL-2 receptor antibodies compared to no induction and to antilymphocyte antibodies in renal transplantation. Am J Transplant. 2007;7(7):1832–42. 10.1111/j.1600-6143.2007.01860.x
17. Boucquemont J, Foucher Y, Masset C, Legendre C, Scemla A, Buron F, et al. Induction therapy in kidney transplant recipients: Description of the practices according to the calendar period from the French multicentric DIVAT cohort. PLoS One. 2020;15(10):e0240929. 10.1371/journal.pone.0240929
18. Cristina D, Ramón C, Mireia C, Elizabeth P, Jose LL, Concepcion GG, et al. Low total dose of anti-human T-lymphocyte globulin (ATG) guarantees a good glomerular filtration rate after liver transplant in recipients with pretransplant renal dysfunction. Can J Gastroenterol Hepatol. 2018;2018:1672621. 10.1155/2018/1672621
19. Song T, Yin S, Li X, Jiang Y, Lin T. Thymoglobulin vs. ATG-Fresenius as induction therapy in kidney transplantation: A Bayesian network meta-analysis of randomized controlled trials. Front. Immunol. 2020;11:457. 10.3389/fimmu.2020.00457
20. Ko H, Min S, Han A, Mo H, Chung CTY, Kim HK, et al. Inferior outcomes of basiliximab compared to anti-thymocyte globulin induction therapy in kidney transplantation with weak pretransplant donor specific anti-hla antibody. Transplantation. 2020;104(3):366. 10.1097/01.tp.0000700404.96761.a6
21. Christophe M, Julie B, Claire G, Fanny B, Emmanuel M, Sophie G, et al. Induction therapy in elderly kidney transplant recipients with low immunological risk. Transplantation. 2020;104(3):613–22. 10.1097/TP.0000000000002804
22. Sang JK, Jinsoo R, Heejin Y, Kyunga K, Kyo WL, Jae BP. Outcome comparison between low-dose rabbit anti-thymocyte globulin and basiliximab in low-risk living donor kidney transplantation. J Clin Med. 2020;9(5):1320. 10.3390/jcm9051320
23. Lee H, Lee S, Jeon JS, Kwon SH, Noh H, Han DC, et al. Thymoglobulin versus basiliximab induction therapy in low-risk kidney transplant recipients: A single-center experience. Transplant. Proc. 2018;50:1285–8. 10.1016/j.transproceed.2018.02.088
24. Hannah K, Marta J, Mathieu H, Benjamin T, Ludovic DA, Pierre P, et al. Different impact of rATG induction on CMV infection risk in D+R-and R+ KTRs. J Infect Dis. 2019;220(5):761–71. 10.1093/infdis/jiz194
25. Marta J, Edoardo M, Elena C, Anna M, Nuria M, Joan T, et al. CMV-specific cell-mediated immunity at 3-month prophylaxis withdrawal discriminates D+/R+ kidney transplants at risk of late-onset CMV Infection regardless the type of induction therapy. Transplantation. 2018;102(11):e472–e480. 10.1097/TP.0000000000002421
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Published
Jan 24, 2023
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How to Cite
Impact of Induction Therapy on Clinical Outcomes of Kidney Transplant Recipients: A Single-Centre Cohort Study. (2023). Journal of Renal and Hepatic Disorders, 7(1), 1-10. https://doi.org/10.15586/jrenhep.v7i1.150
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Original Articles Nephrology
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