In:
Clinical Transplantation, Wiley, Vol. 28, No. 3 ( 2014-03), p. 292-298
Abstract:
While kidney transplant recipients of A frican A merican ( AA ) descent are frequently considered at increased risk of acute rejection, the value of induction therapy is not defined in settings of lower immunologic risk and modern immunosuppression. Methods Using the S cientific R egistry of T ransplant R ecipients database, we identified 23 244 primary kidney transplant recipients with panel‐reactive antibody ( PRA ) = 0% treated with TAC / MPA and prednisone from 2000 to 2008. We compared acute rejection, graft survival ( GS ), and patient survival rates among AA and non‐ AA and further stratified by induction therapy (none, IL 2ra, or r ATG ). Results One‐yr acute rejection was higher in AA than in non‐ AA overall (14.5% vs. 9.9%, hazard ratio [ HR ] for acute rejection [ AR ] 1.43, p 〈 0.0001) and was higher regardless of induction agent use. Induction therapy was associated with a reduction in AR , but no benefit in GS in AA or non‐ AA . In AA , r ATG (adjusted relative risk [ RR ] 0.81, CI 0.70–0.94) and IL 2ra (adjusted RR 0.80, CI 0.68–0.93) were similarly effective in reducing AR rates, but did not reach comparable outcomes as in non‐ AA . Conclusion A frican A mericans who are at otherwise lower immunologic risk have a higher risk of rejection despite modern immunosuppression. Depleting or non‐depleting induction therapy similarly reduces but does not entirely mitigate this increased risk, with no impact on three‐yr GS .
Type of Medium:
Online Resource
ISSN:
0902-0063
,
1399-0012
DOI:
10.1111/ctr.2014.28.issue-3
Language:
English
Publisher:
Wiley
Publication Date:
2014
detail.hit.zdb_id:
2739458-X
detail.hit.zdb_id:
2004801-4
