Anti‐IL‐2R blockers comparing with polyclonal antibodies: Higher risk of rejection without negative mid‐term outcomes after ABO‐incompatible kidney transplantation

Abstract

There is no recommendation regarding the type of induction therapy to use in ABOincompatible (ABOi) kidney transplantation. The aim of this retrospective study was to compare the outcome of ABOi living donor kidney transplant (LDKT) recipients who received either polyclonal antibodies or anti-interleukin-2 receptor (IL-2R) blockers as an induction agent. All ABOi HLA-compatible patients that received a LDKT between 03/11 and 03/18 in three French transplantation center (Paris Saint-Louis, Paris Necker, and Toulouse) were included in the study. Fifty-eight patients were given polyclonal antibodies and 39 patients received anti-IL-2R blockers. We identified by a Cox proportional hazard model the use of polyclonal antibodies as a protective factor against acute rejection (HR = 0.4, 95%CI [0-0.9], P < .05). However, pathological findings on protocol biopsies at 1 year were similar in both groups, as were patient and graft survivals, renal function, and complications. We conclude that the acute rejection rate was significantly higher in patients given anti-IL-2R blockers compared to polyclonal antibodies. However, in our series, there was no negative impact on mid-term outcome.

ABO‐incompatible kidney transplantation in perspective of deceased donor transplantation and induction strategies: a propensity‐matched analysis

“…This is in contrast to the original Swedish protocol that propagated ABOi kidney transplantation reporting very low rejection rates [ 27 ], but the higher rejection rate in our ABOi compared with ABOc recipients is in line with later reports describing cellular rejection rates in up to one‐third of all ABOi kidney transplantation [ 28 , 29 ]. Higher rejection rates were also observed for rituximab/basiliximab versus rituximab/ATG in a single‐center ABOi induction comparison, however, with similar graft survival [ 30 ].…”

ABO‐incompatible living kidney transplantation

“…For recipients with high immunological risk, ATG was suggested as the alternative. To further evaluate long‐term prognosis, Bello et al 47 conducted a retrospective study in three transplant centers in France. They found that the rabbit‐derived (rATG) group was similar to the anti IL‐2 group in terms of patient survival, graft survival rate, and infection complications 1 year after surgery, whereas the biopsy‐proved AMR rate was lower in the rATG group.…”