The Risk of Postkidney Transplant Outcomes by Induction Choice Differs by Recipient Age
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...
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2021-07-01
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doaj-ce71f1fe55b248bdaea208767ca63d8f2021-08-25T06:54:36ZengWolters KluwerTransplantation Direct2373-87312021-07-0177e71510.1097/TXD.0000000000001105202107000-00010The Risk of Postkidney Transplant Outcomes by Induction Choice Differs by Recipient AgeJiYoon B. Ahn, KMD, MPH0Sunjae Bae, KMD, PhD1Nadia M. Chu, PhD, MPH2Lingyu Wang, MBBS3Jongyeon Kim, ScM4Mark Schnitzler, PhD5Gregory P. Hess, MD, MSc6Krista L. Lentine, MD, PhD7Dorry L. Segev, MD, PhD8Mara A. McAdams-DeMarco, PhD91 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.3 Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.4 Department of Emergency Medicine, Drexel College of Medicine, Drexel University, Philadelphia, PA.3 Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.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.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001105 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
JiYoon B. Ahn, KMD, MPH Sunjae Bae, KMD, PhD Nadia M. Chu, PhD, MPH Lingyu Wang, MBBS Jongyeon Kim, ScM Mark Schnitzler, PhD Gregory P. Hess, MD, MSc Krista L. Lentine, MD, PhD Dorry L. Segev, MD, PhD Mara A. McAdams-DeMarco, PhD |
spellingShingle |
JiYoon B. Ahn, KMD, MPH Sunjae Bae, KMD, PhD Nadia M. Chu, PhD, MPH Lingyu Wang, MBBS Jongyeon Kim, ScM Mark Schnitzler, PhD Gregory P. Hess, MD, MSc Krista L. Lentine, MD, PhD Dorry L. Segev, MD, PhD Mara A. McAdams-DeMarco, PhD The Risk of Postkidney Transplant Outcomes by Induction Choice Differs by Recipient Age Transplantation Direct |
author_facet |
JiYoon B. Ahn, KMD, MPH Sunjae Bae, KMD, PhD Nadia M. Chu, PhD, MPH Lingyu Wang, MBBS Jongyeon Kim, ScM Mark Schnitzler, PhD Gregory P. Hess, MD, MSc Krista L. Lentine, MD, PhD Dorry L. Segev, MD, PhD Mara A. McAdams-DeMarco, PhD |
author_sort |
JiYoon B. Ahn, KMD, MPH |
title |
The Risk of Postkidney Transplant Outcomes by Induction Choice Differs by Recipient Age |
title_short |
The Risk of Postkidney Transplant Outcomes by Induction Choice Differs by Recipient Age |
title_full |
The Risk of Postkidney Transplant Outcomes by Induction Choice Differs by Recipient Age |
title_fullStr |
The Risk of Postkidney Transplant Outcomes by Induction Choice Differs by Recipient Age |
title_full_unstemmed |
The Risk of Postkidney Transplant Outcomes by Induction Choice Differs by Recipient Age |
title_sort |
risk of postkidney transplant outcomes by induction choice differs by recipient age |
publisher |
Wolters Kluwer |
series |
Transplantation Direct |
issn |
2373-8731 |
publishDate |
2021-07-01 |
description |
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. |
url |
http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001105 |
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