Edward Drea
Sanofi Cambridge, USA
Title: Graft survival following deceased donor kidney transplantation with ratg Vs basiliximab (bas) induction therapy in recipients at risk of delayed graft function and/or acute rejection
Biography
Biography: Edward Drea
Abstract
Introduction: Studies show conflicting results regarding the long-term impact of induction therapies on kidney graft survival. The srtr database was analyzed for patients transplanted 01/2000–12/2009 who met the inclusion criteria of a prior multicenter study (risk of delayed graft function and/or acute rejection; NEJM 2006; 355: 1967) and received rATG (thymoglobulin®) or BAS induction therapy.
Methods: Registry analysis identified 90,851 deceased donor kidney graft recipients; 51,561 had risk factor status entries and met the increased risk inclusion criteria used in the prior study (NEJM 2006; cold ischemia time [cit] > 24 h, additional risk factors if cit < 24 h). Graft survival was compared for patients with and without each risk factor; Patients with functioning grafts lost to follow-up were excluded. Adjusted Kaplan-Meier survival curves were generated for each risk factor, with other covariates fixed at population means. Hazard models included rATG vs BAS induction.
Results: Of 51,561 patients receiving induction therapy, 35.7% received rATG and 17.4% received BAS. The proportion of patients receiving rATG increased from 14.2% (2000) to 53.3% (2009) ; The proportion receiving BAS declined from 30.2% (2000) to 14.5% (2009). One-year graft survival was 90.7% vs 89.9% for rATG vs BAS, respectively (p=0.02); 5-year graft survival was 69.3% vs 66.7% for rATG vs BAS, respectively (p<0.001). Improved survival for rATG vs BAS was maintained at longer follow-up.
Conclusion: Analyses suggest improved graft survival for rATG vs BAS induction therapy in transplant patients at risk of delayed graft function/rejection.