Author/Authors :
Sureshkumar, Kalathil K. Allegheny General Hospital - Department of Medicine, Division of Nephrology and Hypertension, USA , Hussain, Sabiha M. Allegheny General Hospital - Department of Medicine, Division of Nephrology and Hypertension, USA , Nashar, Khaled Allegheny General Hospital - Department of Medicine, Division of Nephrology and Hypertension, USA , Marcus, Richard J. Allegheny General Hospital - Department of Medicine, Division of Nephrology and Hypertension, USA
Abstract :
The influence of steroid maintenance on the outcomes of repeat kidney transplant (RKT) recipients with respect to induction type is unclear. Using the Organ Procurement and Transplant Network/ United Network of Organ Sharing (OPTN/UNOS) database,we identified patients (≥ 18 years) who underwent deceased donor RKT from January 2000 to December 2008 after receiving induction with rabbit-antithymocyte globulin (r-ATG),alemtuzumab or an IL-2 receptor blocker (IL-2B) and were discharged on a calcineurin inhibitor/mycophenolate mofetil regimen with or without steroids. Of 5634 patients,3643 received r-ATG (steroid = 3157,no-steroid = 486),448 alemtuzumab (steroid = 196,no-steroid = 252) and 1543 an IL-2B (steroid = 1465,no-steroid = 78). Unadjusted graft survivals were similar for the no-steroid versus steroid groups for induction with r-ATG [hazard ratio (HR) 0.85 and 95% confidence interval (95% CI) 0.70-1.03,P = 0.10],alemtuzumab (HR 0.76,95% CI 0.51-1.14,P = 0.18) and IL-2B (HR 0.77,95% CI 0.56-1.70,P = 0.23). In the adjusted model,steroid use improved graft survival in alemtuzumab (HR 0.44,95% CI 0.25-0.76,P = 0.003) but not in the r-ATG (HR 0.86,95% CI 0.68-1.09,P = 0.21) or IL-2B (HR 0.98,95% CI 0.56-1.70,P = 0.94) groups. Steroid use was associated with inferior patient survival in unadjusted (HR 1.30,95% CI 1.17-1.44,P 0.001) and adjusted (HR 1.29,95% CI 1.14-1.45,P 0.001) models for r-ATG induction,whereas this was not observed with alemtuzumab (unadjusted HR 1.11,95% CI 0.89-1.37,P = 0.36; adjusted HR 0.90,95% CI 0.68-1.20,P = 0.49) or IL-2B (unadjusted HR 1.01,95% CI 0.87-1.18,P = 0.87; adjusted HR 1.15,95% CI 0.97-1.38,P = 0.12) inductions. Our study showed a graft survival benefit in the alemtuzumab- and patient death risk in the r-ATG-induced RKT recipients discharged on steroids.
