Outcomes in African-Americans vs. Caucasians Using Thymoglobulin or Interleukin-2 Receptor Inhibitor Induction: Analysis of USRDS Database

Abstract

Aim: We used the USRDS database to test the hypothesis that graft survival was similar using either rabbit antithymocyte globulin (rATG) vs. interleukin-2 receptor inhibitor (IL2i) in the Prograf era. We further explored the variable of race in the two groups of patients. Methods: We conducted a retrospective cohort study of kidney transplant patients in the USRDS from 2000 through 2005 to compare graft survival (including death) using rATG vs. IL2i with particular reference to outcomes between African-Americans vs. Caucasians. Kaplan-Meier analysis was performed to assess patient and graft survival after transplantation, stratified by recipient induction with rATG versus IL2i. Cox regression analysis was performed to assess adjusted survival after transplantation, assessing whether induction rATG (vs. IL2i) was significant as an interaction term (i.e. an effect modifier) with black race for graft survival. Propensity score analysis was used to address potential confounding by indication. Results: In stratified Cox Regression analysis limited to IL2i, black race was significantly associated with graft loss (adjusted hazard ratio (AHR) 1.17, 95% CI, 1.09–1.26). In analysis limited to rATG induction, black race was not significant (AHR 1.00, 95% CI, 0.92–1.10). We detected a significant interaction between rATG and black race (in comparison with non-black race) for the development of graft loss (AHR, 0.86, 95% CI, 0.76–0.97). Analysis limited to black recipients showed that while use of rATG was not significantly different from IL2i (AHR 0.95, 95% CI 0.87–1.04), the direction of this association was in the opposite direction of non-blacks. Conclusions: Patient and graft survival were similar in African-American and Caucasian recipients of kidney transplantation using either rATG or IL2i. Limitations of the study are the retrospective nature of USRDS data, center-bias in using rATG vs. IL2i and lack of data on steroid dosage. Results of the present study call for a critical review of induction practices.

Cytolytic Induction Therapy Improves Clinical Outcomes in African-American Kidney Transplant Recipients

“…Our study also included a 10-year contemporary cohort with substantially longer follow-up, thus allowing for improved power to assess the impact of cytolytic induction therapy on long-term graft survival. 35 Jindal et al 14 analyzed transplant registry data in a 2009 publication, demonstrating that rATG use, as compared with IL-2RA induction therapy, was associated with a nonstatically significant reduction in the risk of graft loss in AAs (aHR 0.95, 95% CI 0.87–1.04). The population of AAs in the Jindal study was 58% smaller (n = 10,568) and had substantially shorter follow-up, as compared with our analysis, which is likely why they were unable to demonstrate a significant difference in long-term patient and graft outcomes.…”

Hand transplantation: current challenges and future prospects

“…[52][53][54][55][56] Induction agents work to deplete the T-and B-cell stores or interfere with the adaptive immune response at the time of alloantigen presentation with transplantation. Induction consists of a polyclonal or monoclonal antibody against thymocytes such as thymoglobulin and alemtuzumab.…”

“…Induction consists of a polyclonal or monoclonal antibody against thymocytes such as thymoglobulin and alemtuzumab. [52][53][54][55][56] This approach has reduced the need for long-term steroid use and the associated cardiovascular risk factors. 57 Once transplantation has taken place, maintenance therapy begins with triple-drug therapy.…”

Induction Immunosuppressive Therapy in Kidney Transplantation

“…Evaluation of data from the United States Renal Data System from 2000 to 2005 showed that the frequency of patient survival and frequency of graft survival were similar in white and black patients who had induction with ATG or IL-2R antibodies. 32 Induction Agents: Discontinued and Investigational Agents efalizumab Efalizumab (Raptiva, Genentech, San Francisco, CA, USA) functions as an immunosuppressant by binding to the CD11a subunit of lymphocyte function-associated antigen 1 and inhibiting white blood cell migration. Efalizumab was indicated for the treatment of chronic moderate-to-severe plaque psoriasis.…”