Multivariate analyses of antibody induction therapies

1. Between 1997-2002 a 3-fold increase in induction therapy was attributed to surging use of Simulect, Zenapax and Thymoglobulin. 2. Induction therapy reduced the hazard ratio by 8% in deceased and 13% in living donor transplants and reduced the risk of rejection by 26% in deceased and 13% in living donor allografts. 3. Thymoglobulin was used more often in sensitized and retransplanted recipients and those with delayed graft function. Zenapax was used more often in pediatric recipients and those receiving MMF. Simulect was used more often in recipients not receiving MMF. 4. Simulect was associated with increased risk of rejection, perhaps due to a negative association with MMF maintenance immunosuppression. On the other hand, recipients not given MMF had a decreased hazard ratio with Simulect induction. 5. Induction reduced the risk of rejection in deceased donor allografts with delayed graft function, and sensitized and Black recipients. However a resultant impact on hazard ratio was not observed in these high-risk cohorts. 6. When considering HLA compatibility, induction reduced the hazard ratio only for DR-mismatched deceased donor allografts. Thymoglobulin induction increased the hazard ratio for zero-haplotype-mismatched living donor transplants.