title: A comparison of three induction therapies on patients with delayed graft function after kidney transplantation.
abstract: We compare the outcomes of induction therapies with either methylprednisolone (group 1, n = 58), basiliximab (group 2, n = 56) or alemtuzumab (group 3, n = 98) in primary deceased donor kidney transplants with delayed graft function (DGF). Protocol biopsies were performed. Maintenance was tacrolimus and mycophenolate with steroid (group 1 and 2) or without steroid (group 3). One-year biopsy-confirmed acute rejection (AR) rates were 27.6, 19.6 and 10.2 % in group 1, 2 and 3 (p = 0.007). AR was significantly lower in group 3 (p = 0.002) and group 2 (p = 0.03) than in group 1. One-year graft survival rates were 90, 96 and 100 % in group 1, 2 and 3 (log rank p = 0.006). Group 1 had inferior graft survival than group 2 (p = 0.03) and group 3 (p = 0.002). The patient survival rates were not different (96.6, 98.2 and 100 %, log rank p = 0.81). Multivariable analysis using methylprednisolone induction as control indicated that alemtuzumab (OR 0.31, 95 % CI 0.11-0.82; p = 0.03) and basiliximab (OR 0.60, 95 % CI 0.23-0.98; p = 0.018) were associated with lower risk of AR. Therefore, alemtuzumab or basiliximab induction decreases AR and improves graft survival than methylprednisolone alone in patients with DGF. Alemtuzumab induction might also allow patients with DGF to be maintained with contemporary steroid-withdrawal protocol.
authors.affiliation: Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, USA.
authors.forename: Afia
authors.initials: A
authors.lastname: Umber
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA, 70112, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Killackey
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA, 70112, USA.
authors.forename: Anil
authors.initials: A
authors.lastname: Paramesh
authors.affiliation: Department of Biostatistics, Tulane University School of Public Health and Tropic Medicine, New Orleans, LA, USA.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Biostatistics, Tulane University School of Public Health and Tropic Medicine, New Orleans, LA, USA.
authors.forename: Huaizhen
authors.initials: H
authors.lastname: Qin
authors.affiliation: Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Atiq
authors.affiliation: Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, USA.
authors.forename: Belinda
authors.initials: B
authors.lastname: Lee
authors.affiliation: Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, USA.
authors.forename: Arnold Brent
authors.initials: AB
authors.lastname: Alper
authors.affiliation: Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Simon
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA, 70112, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Buell
authors.affiliation: Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, USA. rzhang@tulane.edu.
authors.forename: Rubin
authors.initials: R
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects; D000077552:Basiliximab; D016009:Chi-Square Distribution; D051799:Delayed Graft Function / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D060828:Induction Chemotherapy / Q000009:adverse effects / Q000379:methods*; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000187:drug effects* / Q000276:immunology / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D015999:Multivariate Analysis; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000074323:Alemtuzumab; D000077552:Basiliximab; D008775:Methylprednisolone
keywords: Acute rejection; Alemtuzumab; Basiliximab; Delayed graft function; Graft survival; Induction therapy; Kidney transplant; Steroid withdrawal