It is unknown which induction therapy is best for low–immune risk kidney transplant patients. As a result, for a study, researchers evaluated the usage and results of induction immunosuppression in a low-risk group of patients who were serologically matched to their donor at HLA-A, -B, -DR, and -DQB1. The Organ Procurement and Transplant Network reported the first adult kidney-only transplant patients in the United States for the study.
Among the 2,976 patients, 57% were given T cell–depleting antibodies, 28% were given an IL-2 receptor antagonist, and 15% were given no treatment at all. There was no difference in allograft survival, death-censored graft survival, or death with function between patients who received an IL-2 receptor antagonist against those who had no induction treatment. Patients treated with T cell–depleting treatment had a comparable risk of graft loss from any cause, including mortality, in multivariable models (hazard ratio, 1.19; 95% CI, 0.98 to 1.45), compared to patients treated with an IL-2 receptor antagonist or no induction. Subgroup studies of Black recipients, patients categorized by computed panel reactive antibodies, and donation source all yielded similar results. At one year, the incidence of acute rejection was modest (5%), and it did not differ across treatment groups.
Induction therapy with T cell–depleting therapy or IL-2 receptor antagonists was not related to improved post-transplant outcomes in first kidney transplant recipients who were well matched with their donor at the HLA-A, -B, -DR, and -DQB1 gene loci.