Abstract: SA-PO984
Outcomes of Kidney after Liver Transplantation by Induction Type, Stratified by Intertransplant Interval and Immunologic Risk
Session Information
- Transplantation: Clinical - 3
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Cojuc, Gabriel, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Canizares, Stalin, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Rivera, Maria Belen, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Chumdermpadetsuk, Ritah R., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Eckhoff, Devin, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Pavlakis, Martha, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Chopra, Bhavna, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Background
There is no standard induction immunosuppression (IS) for kidney after liver transplants (KALT). Time from liver engraftment and immunologic risk have been hypothesized as effect modifiers for induction therapy-related outcomes. We aimed to assess outcomes in KALT according to induction type, further stratified by inter-transplant intervals and immunologic risk.
Methods
Retrospective UNOS registry cohort study. We selected KALT between 2010 and 2022 who received mycophenolate- and tacrolimus-based maintenance IS. We compared patient death, graft loss, and death-censored graft failure (DCGF) using Cox proportional hazards models in KALT according to induction type (depleting vs. non-depleting), inter-transplant intervals (<1, 1–3, >3 years), and calculated panel reactive antibody (cPRA) (<20, 20–49, 50–80, >80) adjusting for gender, age, ethnicity, steroid use, dialysis vintage, HLA mismatch, cold ischemic time, body mass index, kidney donor profile index, diabetes, and donor characteristics.
Results
We included 1640 KALT (31% female, age 58.5±11 yrs), 61% received depleting, and 39% non-depleting induction IS. There were no statistically significant differences between induction IS groups in patient death (HR 1.01, 95% CI 0.79–1.30), graft loss (0.96, 95% CI 0.76–1.22), and DCGF (HR 1.14, 95% CI 0.86–1.52). The results were consistent when stratifying into inter-transplant intervals; no differences were observed in KALT with <1, 1–3, or >3 years between transplants. Similarly, there were no differences in the outcomes categorized by cPRA (Table).
Conclusion
Induction IS therapies did not impact patient death, graft loss, and DCGF in KALT stratified by inter-transplant intervals and cPRA. The selection of induction IS should be individualized based on immunologic and infection risk.
| Depleting (D) vs. non-depleting (ND) induction in KALT | Adjusted patient death HR (95% CI); p value | Adjusted graft loss HR (95% CI); p value | Adjusted death censored graft loss HR (95% CI); p value |
| All KALT (D = 996; ND = 644) | 1.01 (0.79–1.30); 0.91 | 0.96 (0.76–1.22); 0.75 | 1.14 (0.86–1.52); 0.37 |
| <1 yr post LT (D = 163; ND = 135) | 0.70 (0.22–2.23); 0.55 | 0.49 (0.19–1.25); 0.14 | 1.09 (0.31–3.81); 0.89 |
| 1–3 yr post LT (D = 182; ND = 138) | 1.23 (0.61–2.50); 0.56 | 0.89 (0.46–1.71); 0.73 | 1.35 (0.54–3.37); 0.52 |
| >3 yr post LT (D = 651; ND = 371) | 0.98 (0.74–1.30); 0.90 | 0.97 (0.73–1.28); 0.82 | 1.13 (0.81–1.55); 0.47 |
| cPRA <20 (D = 561; ND = 459) | 1.15 (0.84–1.57); 0.39 | 1.07 (0.79–1.43); 0.68 | 1.16 (0.82–1.65); 0.40 |
| cPRA 20-49 (D = 93; ND = 63) | 0.48 (0.15–1.51); 0.21 | 0.59 (0.18–1.88); 0.37 | 1.96 (0.39–9.80); 0.41 |
| cPRA 50–80 (D = 138; ND = 66) | 0.81 (0.33–1.95); 0.63 | 0.63 (0.27–1.48); 0.29 | 1.20 (0.40–3.61); 0.75 |
| cPRA >80 (D = 204; ND = 56) | 0.59 (0.28–1.25); 0.17 | 0.64 (0.30–1.33); 0.23 | 0.91 (0.34–2.46); 0.85 |