title: The influence of induction therapy for kidney transplantation after a non-renal transplant.
abstract: OBJECTIVE
  Non-renal transplant recipients who subsequently develop ESRD and undergo kidney transplantation are medically and immunologically complex due to comorbidities, high cumulative exposure to immunosuppressants, and sensitization to alloantigen from the prior transplant. Although prior non-renal transplant recipients are one of the fastest growing segments of the kidney wait list, minimal data exist to guide the use of antibody induction therapy (IT+) at the time of kidney after lung (KALu), heart (KAH), and liver (KALi) transplant.
  
  
  METHODS
  This retrospective cohort study used national registry data to examine IT use and survival after kidney transplantation. Separate multivariate Cox regression models were constructed to assess patient survival for IT+ and IT- KALu (n=232), KAH (n=588), and KALi (n=736) recipients.
  
  
  RESULTS
  Use of IT increased during the study period. The percentage of patients considered highly sensitized (panel reactive antibody ≥20%) was not statistically significant between IT+ and IT- groups. IT+ was not associated with improvement in 1- and 10-year patient survival for KALu (P=0.20 and P=0.22, respectively) or for KAH (P=0.90 and P=0.14, respectively). However, IT+ among KALi was associated with inferior patient survival at 1 and 10 years (P=0.04 and P=0.02, respectively).
  
  
  CONCLUSIONS
  Use of IT for kidney transplantation among prior non-renal transplant recipients may not offer a survival advantage in KALu or KAH. However, due to limited power, these findings should be interpreted cautiously. IT+ was associated with inferior outcomes for KALi. Use of IT should be judicially reconsidered in this complex group of recipients.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Cassuto
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Levine
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.forename: Roy D
authors.initials: RD
authors.lastname: Bloom
authors.forename: Simin
authors.initials: S
authors.lastname: Goral
authors.forename: Ali
authors.initials: A
authors.lastname: Naji
authors.forename: Peter L
authors.initials: PL
authors.lastname: Abt
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014184:Transplantation, Homologous
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