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

Afia Umber, Mary Killackey, Anil Paramesh, Yongjun Liu, Huaizhen Qin, Muhammad Atiq, Belinda Lee, Arnold Brent Alper, Eric Simon, Joseph Buell, Rubin Zhang

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)289-295
Number of pages7
JournalJournal of Nephrology
Volume30
Issue number2
DOIs
StatePublished - Apr 1 2017

Fingerprint

Delayed Graft Function
Kidney Transplantation
Methylprednisolone
Graft Survival
Steroids
Survival Rate
Biopsy
Tacrolimus
Therapeutics
Maintenance
Tissue Donors
Transplants
Kidney
alemtuzumab
basiliximab

Keywords

  • Acute rejection
  • Alemtuzumab
  • Basiliximab
  • Delayed graft function
  • Graft survival
  • Induction therapy
  • Kidney transplant
  • Steroid withdrawal

ASJC Scopus subject areas

  • Nephrology

Cite this

A comparison of three induction therapies on patients with delayed graft function after kidney transplantation. / Umber, Afia; Killackey, Mary; Paramesh, Anil; Liu, Yongjun; Qin, Huaizhen; Atiq, Muhammad; Lee, Belinda; Alper, Arnold Brent; Simon, Eric; Buell, Joseph; Zhang, Rubin.

In: Journal of Nephrology, Vol. 30, No. 2, 01.04.2017, p. 289-295.

Research output: Contribution to journalArticle

Umber, A, Killackey, M, Paramesh, A, Liu, Y, Qin, H, Atiq, M, Lee, B, Alper, AB, Simon, E, Buell, J & Zhang, R 2017, 'A comparison of three induction therapies on patients with delayed graft function after kidney transplantation', Journal of Nephrology, vol. 30, no. 2, pp. 289-295. https://doi.org/10.1007/s40620-016-0304-7
Umber, Afia ; Killackey, Mary ; Paramesh, Anil ; Liu, Yongjun ; Qin, Huaizhen ; Atiq, Muhammad ; Lee, Belinda ; Alper, Arnold Brent ; Simon, Eric ; Buell, Joseph ; Zhang, Rubin. / A comparison of three induction therapies on patients with delayed graft function after kidney transplantation. In: Journal of Nephrology. 2017 ; Vol. 30, No. 2. pp. 289-295.
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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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