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Abstract: PO2127

Outcomes of Thymoglobulin vs. Basiliximab Induction Therapies in 2DR Mismatch Living-Donor Renal Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Mohamed, Mahmoud Magdy, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Raza, Hafiz Muhammad Ali, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Ali, Hatem, University Hospital Coventry, Coventry, Coventry, United Kingdom
  • Malik, Shafi, University Hospital Coventry, Coventry, Coventry, United Kingdom
Background

2DR HLA mismatch indicates a high immunological risk of renal transplant. Induction therapy with Thymoglobulin and Basiliximab result in a marked reduction of acute allograft rejection rate and improve graft survival. However, the outcomes in 2DR HLA mismatched renal transplant recipients (RTRs) in the tacrolimus era remain understudied

Methods

Using data from UNOS, all 2 DR mismatched RTRs who were maintained on tacrolimus and mycophenolate mofetil immunotherapy between September 2017 and September 2019 were included. Follow-up data was until September 2020. Patients who received transplants from living donors were included in the study. Collected data included recipient (age, sex, ethnicity, diabetes, body mass index), transplant (delayed graft function, cold ischemia time, number of previous transplants, panel reactive antibodies, HLA-mismatches, induction therapies, maintenance immunotherapy, and donor factors (donor type, donor age). RTRs were divided based on induction therapy into r-ATG and IL-2RA. Instrumental variable regression models were used to assess the effect of induction therapy on acute rejection episodes at 12 months post-transplant, serum creatinine levels at 12 months post-transplant, and graft survival. Type of induction therapy was instrumented for the transplant center to reduce the center effect on the choice of the induction therapy. The regression models were adjusted for the collected recipient, donor, and transplant factors

Results

788 patients received Basilximab while 1727 patients received Thymoglobulin induction. There were no significant differences between Basiliximab versus Thymoglobulin induction in acute rejection episodes at one-year post-transplant (coefficient=-0.229, P value=0.106, 95% Confidence interval:-0.508to 0.049), serum creatinine levels at one-year post-transplant (coefficient=-0.024, P value=0.128, 95% Confidence interval:-0.055to 0.006) or overall graft survival (coefficient=0.008, P value=0.801, 95% CI:-0.001 - 0.001)

Conclusion

The study showed no significant difference in acute rejection episodes or graft survival when using Thymoglobulin or Basiliximab in 2DR HLA mismatched living donor renal transplant recipients in the current tacrolimus-based maintenance immunosuppression era. Therefore, Basiliximab is a safe induction therapy in this group of patients