Late Plasma Cell Depletion After Thymoglobulin Induction in Kidney Transplant Recipients

Outcomes of kidney transplantation in patients with IgA nephropathy based on induction: A UNOS data analysis

INTRODUCTION

IgA nephropathy (IgAN) can cause end-stage kidney disease (ESKD). This study assesses the impact of induction and maintenance immunosuppression on IgAN recurrence, graft survival, and mortality in living and deceased donor kidney transplants (LDKT and DDKT).

METHODS

Retrospective analysis of the UNOS database in adults with ESKD secondary to IgAN who received kidney transplants between January 2000 and June 30, 2022. Patients with thymoglobulin (ATG), alemtuzumab, or basiliximab/daclizumab induction with calcineurin inhibitor (CNI) and mycophenolate mofetil (MMF) with or without prednisone maintenance were analyzed. Multivariate logistic regression was performed to identify factors correlated with IgA recurrence. Multivariable Cox regression analyses were performed for clinically suspected risk factors. Kaplan Meir Analysis was utilized for overall graft survival.

RESULTS

Compared to ATG with steroid maintenance, alemtuzumab with steroid increased the odds of IgAN recurrence in DDKTs (OR 1.90, p < .010, 95% CI [1.169-3.101]). Alemtuzumab with and without steroid increased the odds of recurrence by 52% (p = .036) and 56% (p = .005), respectively, in LDKTs. ATG without steroids was associated with less risk of IgAN recurrence (HR .665, p = .044, 95% CI [.447-.989]), graft failure (HR .758, p = .002, 95% CI [.633-.907]), and death (HR .619, p < .001, 95% CI [.490-.783]) in DDKTs. Recurrence was strongly associated with risks of graft failure in DDKTs and LDKTs and death in LDKTs.

CONCLUSION

In patients with IgAN requiring a kidney transplant, Alemtuzumab induction correlates with increased IgAN recurrence. Relapse significantly affects graft survival and mortality. ATG without steroids is associated with the least graft loss and mortality.

Differences in Early Immunosuppressive Therapy Among Liver Retransplantation Recipients in a National Cohort

BACKGROUND

There is no unified consensus as to the preferred immunosuppression (IS) strategy following liver retransplantation (reLT).

METHODS

This was a retrospective cohort study using the United Network for Organ Sharing database. Recipient, donor, and center characteristics associated with induction use and early maintenance IS regimen were described. Multivariable Cox proportional hazards analysis evaluated induction receipt as a predictor of post-reLT survival.

RESULTS

There were 3483 adult reLT recipients from 2002 to 2018 at 116 centers with 95.6% being performed at the same center as the initial liver transplant. Timing of reLT was associated with induction IS use and the discharge regimen (P < 0.001 for both) but not with regimens at 6- and 12-month post-reLT (P = 0.1 for both). Among late reLTs (>365 d), initial liver disease cause was a more important determinant of maintenance regimen than graft failure cause. Low-reLT volume centers used induction more often for late reLTs (41.1% versus 22.6% high volume; P = 0.002) yet were less likely to wean to calcineurin inhibitors alone in the first year (19.1% versus 38.7% high volume; P = 0.002). Accounting for recipient and donor factors, depleting induction marginally improved post-reLT mortality (adjusted hazard ratio, 0.77; 95% CI, 0.61-0.99; P = 0.08), whereas nondepleting induction had no significant effect.

CONCLUSIONS

Although several recipient attributes inform early IS decision-making, this does not occur in a uniform manner and center factors also play a role. Further studies are needed to assess the effect of early IS on post-reLT outcomes.