Induction outcomes in adult kidney transplantation: Two decades of UNOS data analysis

In the US, 92 % of kidney transplant recipients are treated with induction therapy. This analysis assesses the impact of induction immunosuppression on outcomes such as graft failure, patient mortality, and length of hospitalization.

Retrospective analysis of the UNOS database in adults who received a kidney transplant from January 2000 to June 2022. Analysis focused on induction regimens including anti-thymocyte globulin (ATG), alemtuzumab and basiliximab with maintenance immunosuppression of calcineurin inhibitors, mycophenolate with or without prednisone. Multivariable logistic regression was performed to identify factors correlating with outcomes. Kaplan-Meier product limit method assessed survival.

Alemtuzumab correlated with increased graft failure in deceased-donor and living-donor kidney transplants (HR 1.075 [1.015-1.138] p = 0.013 and HR 1.096 [1.011-1.188] p = 0.026 respectively) and with increased mortality in living-donor kidney transplants (HR 1.215 [1.107-1.332] p < 0.001). Steroids maintenance was associated with fewer acute rejections in both deceased-donor and living-donor kidney transplants (HR = 0.875 [0.84-0.90] p < 0.001 and HR = 0.88 [0.83-0.93] p < 0.001 respectively). Odds of CMV was lower with alemtuzumab. Induction with alemtuzumab was associated with shorter length of stay in both deceased-donor and living-donor kidney transplants and longer time to first hospitalization in living-donor kidney transplants compared to ATG.

Alemtuzumab correlated with shorter length of stay, fewer re-hospitalizations and less CMV infections. However, it was associated with higher odds of graft failure and mortality in adult kidney transplant recipients.