PMID- 31399165
OWN - NLM
STAT- MEDLINE
DCOM- 20191125
LR  - 20211204
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 51
IP  - 6
DP  - 2019 Jul-Aug
TI  - Induction Type and Outcomes in HLA-DR Mismatch Kidney Transplantation.
PG  - 1796-1800
LID - S0041-1345(19)30319-7 [pii]
LID - 10.1016/j.transproceed.2019.04.059 [doi]
AB  - BACKGROUND: In kidney transplantation, donor recipient human leukocyte antigen 
      (HLA)-DR mismatch signals high immunologic risk and portends inferior outcomes. 
      We compared the impacts of depleting vs non-depleting antibody induction on the 
      outcomes in kidney transplant recipients (KTRs) at different levels of HLA-DR 
      mismatches. METHODS: Using the Organ Procurement and Transplantation 
      Network/United Network for Organ Sharing database, we identified adult KTRs from 
      2001 to 2015 who received induction therapy with either depleting 
      (thymoglobulin/alemtuzumab) or non-depleting (basiliximab/daclizumab) antibody 
      and were discharged on calcineurin inhibitor/mycophenolic acid maintenance. 
      Patients were then stratified by the number of donor-recipient HLA-DR mismatches 
      (0, 1, 2) in both living donor (LD) and deceased donor (DD) KTRs. Under each 
      HLA-DR mismatch category, long-term outcomes were compared for depleting vs 
      non-depleting induction using a Cox model. RESULTS: A total of 63,821 LD (HLA-DR 
      mismatches: 0, n = 6945 [depleting = 4409, non-depleting = 2536]; 1, n = 19,557 
      [depleting = 13,558, non-depleting = 6019]; and 2, n = 10,727 [depleting = 7694, 
      non-depleting = 3033]) and 64,922 DD (HLA-DR mismatches: 0, n = 13,915 
      [depleting = 10,124, non-depleting = 3791]; 1, n = 27,994 [depleting = 20,454, 
      non-depleting = 7540]; and 2, n = 23,013 [depleting = 16,908, non-depleting = 
      6105]) KTRs were included in the analysis. Adjusted patient death risk was 
      significantly lower in the depleting vs non-depleting antibody induction group 
      among DD kidney recipients (hazard ratio 0.90, 95% CI 0.85-0.96, P = .001) and 
      trended lower among LD kidney recipients (HR 0.88, 95% 0.79-1.01, P = .05) with 2 
      HLA-DR mismatches. DISCUSSION: Our study found a patient survival benefit 
      associated with the use of perioperative induction with depleting when compared 
      to non-depleting antibody in KTRs with 2 HLA-DR mismatches and maintained on a 
      calcineurin inhibitor/mycophenolic acid regimen.
CI  - Copyright (c) 2019. Published by Elsevier Inc.
FAU - Sureshkumar, Kalathil K
AU  - Sureshkumar KK
AD  - Division of Nephrology and Hypertension, Medicine Institute, Allegheny General 
      Hospital, Allegheny Health Network, Pittsburgh, PA. Electronic address: 
      ksureshk@wpahs.org.
FAU - Chopra, Bhavna
AU  - Chopra B
AD  - Division of Nephrology and Hypertension, Medicine Institute, Allegheny General 
      Hospital, Allegheny Health Network, Pittsburgh, PA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
RN  - 0 (Antibodies)
RN  - 0 (Antilymphocyte Serum)
RN  - 0 (Calcineurin Inhibitors)
RN  - 0 (HLA-DR Antigens)
RN  - 0 (Immunosuppressive Agents)
RN  - 3A189DH42V (Alemtuzumab)
RN  - 9927MT646M (Basiliximab)
RN  - CUJ2MVI71Y (Daclizumab)
RN  - D7RD81HE4W (thymoglobulin)
RN  - HU9DX48N0T (Mycophenolic Acid)
SB  - IM
MH  - Adult
MH  - Alemtuzumab/therapeutic use
MH  - Antibodies/immunology
MH  - Antilymphocyte Serum/immunology/therapeutic use
MH  - Basiliximab/immunology/therapeutic use
MH  - Blood Group Incompatibility/*immunology
MH  - Calcineurin Inhibitors/immunology/therapeutic use
MH  - Contraindications, Procedure
MH  - Daclizumab/immunology/therapeutic use
MH  - Databases, Factual
MH  - Female
MH  - Graft Survival/*immunology
MH  - HLA-DR Antigens/*immunology
MH  - Histocompatibility Testing
MH  - Humans
MH  - Immunosuppression Therapy/*methods
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Kidney/immunology
MH  - Kidney Transplantation/*adverse effects
MH  - Living Donors
MH  - Male
MH  - Middle Aged
MH  - Mycophenolic Acid/immunology/therapeutic use
MH  - Proportional Hazards Models
MH  - Treatment Outcome
EDAT- 2019/08/11 06:00
MHDA- 2019/11/26 06:00
CRDT- 2019/08/11 06:00
PHST- 2019/02/19 00:00 [received]
PHST- 2019/04/11 00:00 [accepted]
PHST- 2019/08/11 06:00 [entrez]
PHST- 2019/08/11 06:00 [pubmed]
PHST- 2019/11/26 06:00 [medline]
AID - S0041-1345(19)30319-7 [pii]
AID - 10.1016/j.transproceed.2019.04.059 [doi]
PST - ppublish
SO  - Transplant Proc. 2019 Jul-Aug;51(6):1796-1800. doi: 
      10.1016/j.transproceed.2019.04.059.