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Clinical Outcomes Associated With Induction Regimens Among Retransplant Kidney Recipients in the United States

Schold, Jesse1; Poggio, Emilio2; Goldfarb, David2; Kayler, Liise3; Flechner, Stuart2

doi: 10.1097/TP.0000000000000507
Original Clinical Science

Background: Numerous studies have evaluated outcomes and risk factors associated with induction protocols among kidney transplant recipients. However, few studies have evaluated outcomes in the subset of retransplant recipients who often have unique immunologic condition and risk profile and represent an increasing proportion of transplant patients in the United States.

Methods: We evaluated the association of common induction treatments (alemtuzumab, thymoglobulin, interleukin-2 receptor blockers, and no induction) given at transplantation with clinical outcomes among adult recipients retransplant between 2003 and 2011 using national Scientific Registry of Transplant Recipients data (n = 14,336). We used a propensity score analysis to minimize potential selection biases for allocation of treatment.

Results: In adjusted models, there were no significant differences between induction groups for outcomes of delayed graft function, 1-year acute rejection, 1-year BK virus or patient death. Acute rejection before hospital discharge was lowest among patients treated with thymoglobulin and alemtuzumab. The no induction group had the highest average 1-year estimated glomerular filtration rate (62 mL/min/1.73kg/m2) and lowest incidence of any malignancies within 1 year (1.0%). Hospitalizations after transplantation were highest among patients treated with thymoglobulin (42% at 1 year). Recipients with alemtuzumab had the highest relative risk for graft loss (adjusted hazard ratio, 1.19; 95% confidence interval, 1.01–1.40, relative to patients treated with thymoglobulin).

Conclusion: There is moderate variation in clinical outcomes associated with induction treatment among retransplant kidney recipients in the United States, including higher graft loss rates among recipients treated with alemtuzumab but similar patient survival between all regimens.

A retrospective US-based re gistry analysis of induction immunosuppression for kidney retransplantation reveals variable but small differences in outcomes. The data do not identify a single preferred algorithm for retransplant induction therapy.

1 Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.

2 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.

3 Department of Surgery, Montefiore Medical Center, Bronx, NY.

Received 14 February 2014. Revision requested 10 March 2014.

Accepted 17 September 2014.

Funding for this study was provided by Sanofi, Inc. Dr. Schold received support from Sanofi, Inc. to conduct this study. No other authors received support for this study.

The authors declare no conflicts of interest.

The data reported here have been supplied by the Minneapolis Medical Research Foundation as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government.

J.S., E.M., D.G., L.K., S.F. participated in research design and writing of the article. J.S. participated in data analysis.

Correspondence: Jesse D. Schold, Ph.D., Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, JJN3-01, Cleveland, OH 44195. (

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