Abstract: SA-PO007
Utility of Induction Agents in Simultaneous Liver-Kidney Transplantation
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
- AbdulRahim, Nashila, UT Southwestern Medical Center, Dallas, Texas, United States
- Kotla, Suman Krishna, UT Southwestern Medical Center, Dallas, Texas, United States
- Anderson, Lee E., UT Southwestern Medical Center, Dallas, Texas, United States
- Liu, Hao, UT Southwestern Medical Center, Dallas, Texas, United States
- Tanriover, Bekir, UT Southwestern Medical Center, Dallas, Texas, United States
- Ariyamuthu, Venkatesh Kumar, UT Southwestern Medical Center, Dallas, Texas, United States
Background
The number of simultaneous liver-kidney transplants (SLKT) and utilization of induction therapy in SLKT is on the rise. There is little published evidence of utility of induction agents when contemporary maintenance immunosuppression regimen with tacrolimus, mycophenolic acid, and prednisone (TAC/MPA/PRED) is used.
Methods
We queried the OPTN registry for adult SLKT recipients in the US between 2002-2016. We divided the cohort into three groups based on induction agent: rabbit anti-thymocyte globulin (r-ATG, N=436), interleukin 2 receptor antagonists (IL2-RA, N=1,189) and no-induction (N=1,763) being the reference group. All patients were maintained on TAC/MPA/PRED at the time of discharge. The primary outcomes were post-transplant all-cause mortality and acute rejection rates at 6 months. Survival rates were analyzed using Kaplan-Meier (KM) method and compared between groups using the log rank test. We estimated hazard and odd ratios for our primary outcomes using a propensity score analysis (inverse probability weighting -IPW) adjusted Cox proportional hazard and logistic regression models.
Results
Compared with no-induction, the multivariable IPW adjusted Cox proportional hazard analyses showed an increased mortality with r-ATG (HR=1.31, 95% CI 1.04-1.65, p-value=0.02). At six-months post-transplant, acute rejection rates (both liver and kidney) were less than 10% and were not statistically significant between three induction categories based on multivariable IPW adjusted logistic regression analysis. Mortality secondary to infection was statistically higher in r-ATG group.
Conclusion
In SLKT recipients maintained on TAC/MPA/PRED, induction categories were associated with similar rejection rates at six-months. Compared to no induction, r-ATG appears to increase mortality risk, probably secondary to infections. Benefit of IL2-RA induction in SLKT remains controversial.