title: The Privilege of Induction Avoidance and Calcineurin Inhibitors Withdrawal in 2 Haplotype HLA Matched White Kidney Transplantation.
abstract: BACKGROUND
  White recipients of 2-haplotype HLA-matched living kidney transplants are perceived to be of low immunologic risk. Little is known about the safety of induction avoidance and calcineurin inhibitor withdrawal in these patients.
  
  
  METHODS
  We reviewed our experience at a single center and compared it to Organ Procurement and Transplantation Network (OPTN) registry data and only included 2-haplotype HLA-matched white living kidney transplants recipients between 2000 and 2013.
  
  
  RESULTS
  There were 56 recipients in a single center (where no induction was given) and 2976 recipients in the OPTN. Among the OPTN recipients, 1285 received no induction, 903 basiliximab, 608 thymoglobulin, and 180 alemtuzumab. First-year acute rejection rates were similar after induction-free transplantation among the center and induced groups nationally. Compared with induction-free transplantation in the national data, there was no decrease in graft failure risk over 13 years with use of basiliximab (adjusted hazard ratio [aHR], 0.86; confidence interval [CI], 0.68-1.08), Thymoglobulin (aHR, 0.92; CI, 0.7-1.21) or alemtuzumab (aHR, 1.18; CI, 0.72-1.93). Among induction-free recipients at the center, calcineurin inhibitor withdrawal at 1 year (n = 27) did not significantly impact graft failure risk (HR,1.62; CI, 0.38-6.89).
  
  
  CONCLUSIONS
  This study may serve as a foundation for further studies to provide personalized, tailored, immunosuppression for this very low-risk population of kidney transplant patients.
authors.affiliation: Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Brifkani
authors.affiliation: Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.; Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Horwedel
authors.affiliation: Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Malone
authors.affiliation: Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
authors.forename: Rowena
authors.initials: R
authors.lastname: Delos Santos
authors.affiliation: Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
authors.forename: Thin Thin
authors.initials: TT
authors.lastname: Maw
authors.affiliation: Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO.; Transplant Epidemiology Research Collaboration (TERC), Institute of Public Health, Washington University School of Medicine, St. Louis, MO.
authors.forename: Tarek
authors.initials: T
authors.lastname: Alhamad