Should heart, lung, and liver transplant recipients receive immunosuppression induction for kidney transplantation?

Abstract

As the outcomes of heart, liver, and lung transplantation continue to improve, more patients will present for subsequent renal transplantation. It remains unclear whether these patients benefit from induction immunosuppression. We retrospectively reviewed induction on solid organ graft recipients who underwent renal transplant at our center from January 1, 1995 to March 30, 2007. Induction and the non-induction groups were compared by univariate and Kaplan-Meier analyses. There were 21 patients in each group, with mean follow-up of 4.5-6.0 years. Forty-seven percent of patients receiving induction had a severe post-operative infection, compared with 28.6% in the non-induction group (p = NS). The one yr rejection rate in the induction group was 9.5% compared with 14.3% for non-induction (p = NS). One-yr graft survival was 81.0% and 95.2% in the induction and non-induction group (p = NS). In summary, there is a trend toward lower patient and graft survival among patients undergoing induction. These trends could relate to selection bias in the decision to prescribe induction immunosuppression, but further study is needed to better define the risks and benefits of antibody-induction regimens in this population.

The Influence of Induction Therapy for Kidney Transplantation after a Non-Renal Transplant

“…Evidence to help make informed decisions regarding induction therapy in patients presenting for kidney after liver (KALi), kidney after lung (KALu), and kidney after heart (KAH) transplants is sparse (17). The aims of this study were to examine national trends with regard to induction therapy and to determine whether there is evidence of benefit in the use of antibody induction therapy in a medically and immunologically challenged group of transplant recipients.…”