Journal article
The Risk of Postkidney Transplant Outcomes by Induction Choice Differs by Recipient Age
TRANSPLANTATION DIRECT, v 7(7), e715
Jul 2021
PMID: 34476294
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background. Among adult kidney transplant (KT) recipients, the risk of post-KT adverse outcomes differs by type of induction immunosuppression. Immune response to induction differs as recipients age; yet, choice of induction is barely tailored by age likely due to a lack of evidence of the risks and benefits. Methods. Using Scientific Registry of Transplant Recipients data, we identified 39336 first-time KT recipients (2010-2016). We estimated the length of stay (LOS), acute rejection (AR), graft failure, and death by induction type using logistic and Cox regression weighted by propensity score to adjust for confounders. We tested whether these estimates differed by age (65+ versus 18-64 y) using a Wald test. Results. Overall, rabbit antithymocyte globulin (rATG) was associated with a decreased risk of AR (odds ratio = 0.79, 95% confidence interval [CI], 0.72-0.85) compared with basiliximab. The effect of induction on LOS and death (interaction P = 0.03 and 0.003) differed by recipient age. Discharge was on average 11% shorter in rATG among younger recipients (relative time = 0.89; 95% confidence interval [CI], 0.81-0.99) but not among older recipients (relative time = 1.01; 95% CI, 0.95-1.08). rATG was not associated with mortality among older (hazard ratio = 1.05; 95% CI, 0.96-1.15), but among younger recipients (hazard ratio = 0.87; 95% CI, 0.80-0.95), it was associated with reduced mortality risk. Conclusions. rATG should be considered to prevent AR, especially among recipients with high-immunologic risk regardless of age; however, choice of induction should be tailored to reduce LOS and risk of mortality, particularly among younger recipients.
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Details
- Title
- The Risk of Postkidney Transplant Outcomes by Induction Choice Differs by Recipient Age
- Publication Details
- TRANSPLANTATION DIRECT, v 7(7), e715
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
- Grant note
- This study was supported by the National Institute of Diabetes and Digestive and Kidney Disease and the National Institute of Aging: grant numbers K24DK101828 (PI: D.L.S.), R01AG055781 (PI: M.A.M.-D.), and R01DK114074 (PI: M.M.-D.). S.B. was supported by the American Society of Nephrology.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel University
- Web of Science ID
- WOS:000670036600010
- Scopus ID
- 2-s2.0-85109382825
- Other Identifier
- 991021860663704721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Transplantation