Abstract: SA-PO015
Induction Therapy in Elderly Kidney Transplant Recipients with Low Immunological Risk
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Masset, Christophe, Nantes University Hospital, Nantes, France., Nantes, France
- Boucquemont, Julie, Université de Nantes; UMR INSERM 1246 - SPHERE, Nantes, France
- Buron, Fanny, Hospices Civils de Lyon, Lyon, France
- Garrigue, Valerie, University Hospital Montpellier, Montpellier, France
- Cassuto, Elisabeth, chu Nice, NICE Cedex 3, France
- Ladrière, Marc, CHRU NANCY, Vandoeuvre les Nancy, France
- Foucher, Yohann, Université de Nantes; UMR INSERM 1246 - SPHERE, Nantes, France
- Dantal, Jacques, Nantes University Hospital, Nantes, France., Nantes, France
Background
Thymoglobulin (ATG) and Basiliximab (BSX) lead to similar rejection rates in low immunological risk patients. ATG could be benefit on Delayed Graft Function (DGF) and allow corticosteroid avoidance, supporting its use in elderly recipients. In contrast, it seems to be associated with infectious and malignancy risk, supporting the use of BSX, especially in recipients with low immunological risk. The benefit-risk balance remains unclear. We thus compared post-transplantation outcomes in elderly recipients with low immunological risk according to their induction therapy.
Methods
We conducted a French multicentric study on non-immunized ≥ 65 years patients receiving a first kidney transplant between 2010 and 2017 and an induction therapy by ATG or BSX. The principal outcome was patient and graft survival. We also studied the cumulative probabilities of infection, first acute rejection episode, malignancy; de novo DSA and eGFR at 1-year post transplantation; and occurrence of DGF. Cox, logistic or linear models were used depending on the studied outcome. To consider possible confounding variables, we weighted the models on the propensity scores.
Results
204 (53.3%) patients were included in the BSX group, 179 (46.7%) in the ATG group. Average age was respectively 71.0 and 70.5 years. Patient and graft survival at 3 years post-transplantation were 74% (95%CI from 65% to 84%) in the ATG group, and 68% (95%CI from 60% to 78%) in the BSX group. The corresponding HR (Hazard Ratio) equalled 0.96 between the BSX group compared to the ATG group (95%CI from 0.58 to 1.60). The probability of infection at 1-year post-transplantation were 52% (95%CI from 59% to 44%) in the BSX group versus 51% (95%CI from 59% to 42%) in the ATG group, without significant difference. There was no difference in all the others evaluated outcomes as indicated in Figure 1.
Conclusion
In elderly recipients, induction therapy by ATG does not seem to lead to poorer outcomes compared to BSX.