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Induction Therapy, Rejection, and Graft Outcomes in Pediatric and Adolescent Kidney Transplant Recipients

Mincham, Christine Marie MBBS1; Wong, Germaine PhD2,3,4,5; Teixeira-Pinto, Armando PhD5; Kennedy, Sean PhD6,7; Alexander, Stephen PhD8; Larkins, Nicholas FRACP1; Lim, Wai H. PhD9,10

doi: 10.1097/TP.0000000000001577
Original Clinical Science—General

Background Although the clinical benefit of interleukin-2-receptor antibody (IL-2RAb) induction in reducing the risk of acute rejection in adult kidney transplant recipients is well established, a similar benefit in pediatric recipients remains controversial. The aim of this study is to evaluate the efficacy of IL-2RAb in reducing acute rejection in pediatric and adolescent recipients aged 21 years or younger using Australia and New Zealand Dialysis and Transplant registry.

Methods The association between IL-2RAb induction and risk of acute rejection was examined using adjusted logistic regression and propensity score analyses, whereby the associations between induction, graft loss, and incident cancer were examined using adjusted Cox regression analysis.

Results There were 658 recipients followed up for a median of 5.5 years between 2001 and 2012. The use of IL-2RAb induction was associated with adjusted odds ratios of 0.61 (95% confidence interval [CI], 0.41-0.91; P = 0.007) for any rejection and 0.57 (95% CI, 0.35-0.92; P = 0.020) for early rejection occurring in the first 6 months after transplant. These associations were attenuated in the propensity score analysis but remained statistically significant with adjusted odds ratio of 0.65 (95% CI, 0.49-0.87) for any rejection and 0.64 (95% CI, 0.44-0.93) for early rejection. There were no associations between induction, graft loss, and incident cancer.

Conclusions Induction treatment of IL-2RAb in pediatric and adolescent kidney transplant recipients is associated with at least a 40% reduction in the odds of acute rejection, independent of age, era, immunological status, and initial immunosuppression.

This cohort retrospective registry analysis including 658 pediatric and adolescent kidney transplant recipients followed shows that induction treatment with IL-2RAb is independently associated with reduced risk of acute rejection but not with graft loss after a median follow up time of 5.5 years.

1 Department of Nephrology, Princess Margaret Hospital for Children, Perth, Australia.

2 Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia.

3 Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia.

4 Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia.

5 Sydney School of Public Health, University of Sydney, Sydney, Australia.

6 School of Women’s & Children’s Health, UNSW Medicine, University of New South Wales, Sydney, Australia.

7 Department of Nephrology, Sydney Children’s Hospital Randwick, Sydney, Australia.

8 Paediatrics & Child Health, Westmead Children's Hospital, Sydney, Australia.

9 Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.

10 School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, University of Western Australia, Perth, Australia.

Received 5 April 2016. Revision received 21 October 2016.

Accepted 23 October 2016.

The data reported here have been supplied by ANZDATA. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of ANZDATA.

A.T.-P. is partially supported by the NHMRC Program Grant APP1092957.

The authors declare no conflicts of interest.

W.H.L. and C.M. participated in the research design, data analysis, and writing of the article. A.T.-P. contributed to the statistical analysis and the final draft. All other authors participated in the writing of the article.

Correspondence: Wai H Lim, PhD, Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia 6009. (

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