title: Lymphocyte-depleting induction therapy lowers the risk of acute rejection in African American pediatric kidney transplant recipients.
abstract: The use of lymphocyte-depleting induction immunosuppression has been associated with a reduction in risk of AR after KT among adult recipients, particularly among high-risk subgroups such as AAs. However, data on induction regimen and AR risk are lacking among pediatric KT recipients. We examined outcomes among 7884 first-time pediatric KT recipients using SRTR data (2000-2014). Characteristics were compared across race using Wilcoxon rank-sum tests for continuous and chi-square tests for categorical variables. Risk of AR was estimated using modified Poisson regression, stratified by recipient race, adjusting for recipient age, gender, BMI, primary diagnosis, number of HLA mismatches, maintenance immunosuppression, and donor type. Risk of AR within 1 year was lower in AA recipients receiving lymphocyte-depleting induction (ATG or alemtuzumab; RR, 0.66; 95% CI, 0.52-0.83 P < .001) compared to AA recipients receiving anti-IL-2 receptor antibody induction. This difference was not seen in non-AA recipients receiving lymphocyte-depleting induction (RR, 0.93; 95% CI, 0.81-1.06, P = .26) compared to IL-2 induction. These findings support a role for lymphocyte-depleting induction agents in AA pediatric patients undergoing KT and continued use of IL-2 inhibitor induction in non-AA pediatric KT recipients.
authors.affiliation: Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Cole N
authors.initials: CN
authors.lastname: Crowson
authors.affiliation: Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Rhiannon D
authors.initials: RD
authors.lastname: Reed
authors.affiliation: Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Brittany A
authors.initials: BA
authors.lastname: Shelton
authors.affiliation: Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: MacLennan
authors.affiliation: Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Jayme E
authors.initials: JE
authors.lastname: Locke
mesh_terms: D000293:Adolescent; D001741:Black or African American; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation / Q000379:methods*; D008214:Lymphocytes / Q000166:cytology*; D008222:Lymphokines / Q000627:therapeutic use; D008297:Male; D015233:Models, Statistical; D051437:Renal Insufficiency / Q000208:ethnology* / Q000601:surgery*; D015203:Reproducibility of Results; D012306:Risk
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D008222:Lymphokines; C046147:interleukin 2 inhibitor; D000074323:Alemtuzumab
keywords: induction immunosuppression; pediatric kidney transplantation; rejection