INDUCTION IMMUNOSUPPRESSION

R.M. Croke
Nephrology, Royal Perth Hospital, Perth/WA/AUSTRALIA

Body: EFFECT OF INDUCTION THERAPY ON ACUTE REJECTION RISK AND SEVERITY, INFECTION AND MALIGNANCY-RELATED MORTALITY IN RENAL TRANSPLANT RECIPIENTS CROKE, Rebecca, DENT, Hannah, CAMPBELL, S, CHADBAN, S, RUSS, G, McDONALD, Stephen, LIM, Wai. Sir Charles Gairdner Hospital, Perth, WESTERN AUSTRALIA & ANZDATA Transplant Working Group, Adelaide, SOUTH AUSTRALIA. Aims: In renal transplantation, the use of interleukin-2 receptor antibody (IL-2Ra) and T cell depletive antibody induction (T cell Ab) has been associated with reduced rejection risk but it remains unclear which induction agent is more efficacious. The aim of the present study is to determine the effect of induction agents on renal allograft and patient outcomes, including the risk of infection and malignancy-related mortality. Methods: Using Australia and New Zealand Dialysis and Transplant Registry, all live- and deceased-donor renal transplant recipients in Australia between 2000-2006 were included. Outcomes analysed included acute rejection, estimated glomerular filtration rate (eGFR) at 1 and 5 years, graft and patient survival, infection and malignancy rates. Results: Of the 3452 renal transplant recipients, 1874 (54.3%) received no induction, 1470 (42.6%) received IL-2Ra and 108 (3.1%) received T cell Ab. Induction agents were used in highly sensitized recipients. Compared with no induction, IL-2Ra but not T cell Ab was associated with reduced rejection risk (relative risk 0.70, 95%CI 0.60, 0.81) and higher eGFR at 5 years (difference in means 3.51, 95%CI 0.83, 6.19). Compared with no induction, there was no association between induction therapies and severity of rejection, vascular rejection or multiple rejection episodes. The adjusted rate of death attributed to malignancy for no induction, IL-2Ra and T cell Ab per 1000-patient years was 1.48, 1.63 and 2.28 respectively, whereas death attributed to infection was 2.42, 2.16 and 0.95 respectively. Conclusion: This registry analysis demonstrates that IL-2Ra induction in kidney transplantation is associated with substantial clinical benefits of reduced risk of acute rejection and improved long-term graft function compared to no induction therapy or the use of T cell Ab.

Disclosure: All authors have declared no conflicts of interest.