Kidney Week

Abstract: PO2134

Renal Outcome and Infectious Complications Associated with Induction Regimens for Kidney Transplantation Among Children: A NAPRTCS and PHIS Collaborative Study

Session Information

• Transplantation: Clinical - Underrecognized Risk Factors, Traditional Considerations, and Outcomes
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Levy Erez, Daniella, The Children's Hospital of Philadelphia, Philadelphia, United States

Daniella Levy Erez, MD, MS

• Pizzo, Helen, Cedars-Sinai Medical Center, Los Angeles, California, United States

Helen Pizzo,

• Rodig, Nancy MacDonald, Boston Children's Hospital, Boston, Massachusetts, United States

Nancy MacDonald Rodig,

• Richardson, Troy, Children's Hospital Association, Overland Park, Kansas, United States

Troy Richardson,

• Somers, Michael J., Boston Children's Hospital, Boston, Massachusetts, United States

Michael J. Somers,

Background

Few studies compare induction agents in pediatric kidney transplants (KTx), and induction is often guided by local practice more so than specific outcome data. We evaluated how different agents affected outcomes in children enrolled in both the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry and the Pediatric Health Information System (PHIS).

Methods

Retrospective study of merged data from NAPRTCS and PHIS between 1999-2019. Participants grouped by induction agent: no induction, IL2 RB only, rATG/ALG, alemtuzumab. Estimated GFR (eGFR) was calculated with adjustments for age, diagnosis, repeat KTx status, delayed graft function, and rejection. Subgroup analysis evaluated rejection rates and infectious complications between 2009-2019. Outcomes were compared using chi-square or Kruskal-Wallis tests.

Results

2410 KTx recipients with data in both datasets were identified. 340 subjects (14.1%) received no induction, 960 (39.8%) IL2 RB only, 934 (39.1%) ATG/ALG, and 176 (7.3%) alemtuzumab. Table 1highlights eGFR decline, using ratios obtained by dividing any year’s eGFR by the preceding year. Annual decline in eGFR was slower in the ATG/ALG group vs IL2RB or alemtuzumab and higher among children transplanted between ages 0-4 years. Table 2 summarizes rejection and infectious frequencies. Alemtuzumab had lower rates of rejection and BK viremia compared to IL2RB and ATG/ALG.

Conclusion

Longitudinal decline in eGFR was similar across all induction agents, though decline with ATG/ALG was lowest. Although rejection and BK viremia was lowest with alemtuzumab, there was no difference with EBV or CMV infection or post-KTx malignancy.

Table 1: Annual change in eGFR

Table 2: Outcomes by induction therapy between 2009-2019

Funding

• Private Foundation Support