Comparing Outcomes between Antibody Induction Therapies in Kidney Transplantation.
Kidney transplant recipients often receive antibody induction. Previous studies of induction therapy were often limited by short follow-up and/or absence of information about complications. After linking Organ Procurement and Transplantation Network data with Medicare claims, we compared outcomes between three induction therapies for kidney recipients. Using novel matching techniques developed on the basis of 15 clinical and demographic characteristics, we generated 1:1 pairs of alemtuzumab-rabbit antithymocyte globulin (rATG) (5330 pairs) and basiliximab-rATG (9378 pairs) recipients. We used paired Cox regression to analyze the primary outcomes of death and death or allograft failure. Secondary outcomes included death or sepsis, death or lymphoma, death or melanoma, and healthcare resource utilization within 1 year. Compared with rATG recipients, alemtuzumab recipients had higher risk of death (hazard ratio [HR], 1.14; 95% confidence interval [95% CI], 1.03 to 1.26;P<0.01) and death or allograft failure (HR, 1.18; 95% CI, 1.09 to 1.28;P<0.001). Results for death as well as death or allograft failure were generally consistent among elderly and nonelderly subgroups and among pairs receiving oral prednisone. Compared with rATG recipients, basiliximab recipients had higher risk of death (HR, 1.08; 95% CI, 1.01 to 1.16;P=0.03) and death or lymphoma (HR, 1.12; 95% CI, 1.01 to 1.23;P=0.03), although these differences were not confirmed in subgroup analyses. One-year resource utilization was slightly lower among alemtuzumab recipients than among rATG recipients, but did not differ between basiliximab and rATG recipients. This observational evidence indicates that, compared with alemtuzumab and basiliximab, rATG associates with lower risk of adverse outcomes, including mortality.
School of Arts and Sciences and.
Neel
N
Koyawala
Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Department of Pediatrics.
Jeffrey H
JH
Silber
Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania.
Paul R
PR
Rosenbaum
Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Wei
W
Wang
Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Alexander S
AS
Hill
Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Joseph G
JG
Reiter
Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Bijan A
BA
Niknam
Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Orit
O
Even-Shoshan
Renal Electrolyte and Hypertension Division, Department of Medicine, and.
Roy D
RD
Bloom
Renal Electrolyte and Hypertension Division, Department of Medicine, and.
Deirdre
D
Sawinski
Departments of Surgery and.
Susanna
S
Nazarian
Renal Electrolyte and Hypertension Division, Department of Medicine, and.|Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and.
Jennifer
J
Trofe-Clark
Renal Electrolyte and Hypertension Division, Department of Medicine, and.
Mary Ann
MA
Lim
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
Jesse D
JD
Schold
Renal Electrolyte and Hypertension Division, Department of Medicine, and peter.reese@uphs.upenn.edu.|Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Peter P
PP
Reese
D000368:Aged; D000369:Aged, 80 and over; D000074323:Alemtuzumab; D000818:Animals; D000906:Antibodies / Q000276:immunology*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D000077552:Basiliximab; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011817:Rabbits; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000906:Antibodies; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000074323:Alemtuzumab; D000077552:Basiliximab
acute rejection; cancer; immunosuppression; survival; transplant outcomes