Efficacy of induction therapy on acute rejection and graft outcomes in African American kidney transplantation.
BACKGROUND
African Americans (AA) have higher rejection rates and poorer graft outcomes compared to non-AAs. Induction therapy is yet unproven in this high risk population.


METHODS
This retrospective study compared the efficacy of induction therapy [IL-2 receptor antibodies (IL2RA) or thymoglobulin] vs. no induction.


RESULTS
One hundred and seventy-five AA patients were included in this analysis. Patients were well matched for demographic and immunologic characteristics in the non-induction and IL2RA induction groups; the Thymoglobulin induction group had significantly higher risk patients. Significantly fewer episodes of acute rejection occurred at one yr in patients treated with thymoglobulin and IL2RA vs. no induction (18% vs. 47%, p = 0.003, 26% vs. 47%, p = 0.02). Three yr graft survival was significantly improved in the IL2RA group compared to the non-induction group (85% vs. 68%, p = 0.032). Despite the thymoglobulin group being at high risk, they had similar graft survival rates compared to both the IL2RA group (76% vs. 85%, p = 0.18) and the non-induction group (76% vs. 68%, p = 0.48). Multivariate analysis demonstrated that induction therapy (combining IL2RA and thymoglobulin) independently reduced the risk of both acute rejection and graft loss.


CONCLUSIONS
The use and type of induction therapy in AA patients significantly reduces acute rejection rates and may improve long-term graft outcomes in AA patients.
Hammond
Emily B
EB
College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Taber
David J
DJ
Weimert
Nicole A
NA
Egidi
Maria F
MF
Bratton
Charles F
CF
Lin
Angello
A
McGillicuddy
John W
JW
Chavin
Kenneth D
KD
Baliga
Prabhakar K
PK
D000328:Adult; D001741:Black or African American; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum; D000077552:Basiliximab; D015331:Cohort Studies; D000077561:Daclizumab; D005260:Female; D006084:Graft Rejection / Q000208:ethnology* / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053645:Interleukin-2 Receptor alpha Subunit / Q000037:antagonists & inhibitors; D007674:Kidney Diseases / Q000208:ethnology / Q000276:immunology / Q000601:surgery*; D016030:Kidney Transplantation / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D053645:Interleukin-2 Receptor alpha Subunit; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D000077561:Daclizumab; C512542:thymoglobulin