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Efficacy and Safety of Induction Therapy in Kidney Transplant Recipients: A Propensity Score Matching Analysis in a

Vural Taner Yılmaz1, Erol Demir2, Hüseyin Koçak1

  • 1Department of Internal Medicine, Division of Nephrology, Akdeniz University Faculty of Medicine, Antalya, Türkiye.

Transplantation Proceedings
|May 1, 2025
PubMed
Abstract

Insights

Anti-T lymphocyte globulin (ATLG) induction in kidney transplants shows benefits for high-risk patients but increases infection and antibody risks. For low-moderate risk patients, induction therapy

Area of Science:

  • Nephrology
  • Immunology
  • Transplantation Medicine

Background:

  • Kidney transplantation requires effective immunosuppression to prevent rejection.
  • Induction therapy is a common strategy to manage immunosuppression post-transplant.

Purpose of the Study:

  • To compare the efficacy and safety of different induction treatments in kidney transplant recipients.
  • To evaluate outcomes based on induction therapy type: no induction, Anti-T lymphocyte globulin (ATLG), and Basiliximab.

Main Methods:

  • A retrospective study of 2564 kidney transplant recipients across 15 centers.
  • Patients were grouped based on induction therapy: None (n=222), ATLG (n=1794), Basiliximab (n=548).
  • Outcomes were assessed at 1 month, 1-6 months, and 6-12 months post-transplant, with propensity score matching (PSM) applied.

Main Results:

  • Before PSM, ATLG group showed higher rates of donor-specific antibodies (DSA), cytomegalovirus (CMV) infection, general infections, and delayed graft function (DGF).
  • After PSM, rejection rates (only in the first month), graft/patient loss, and BKV incidence were comparable between ATLG and Basiliximab groups.
  • Elevated infection, CMV, and DSA rates persisted in the ATLG group; outcomes for no induction and Basiliximab groups were similar.

Conclusions:

  • ATLG demonstrates clinical benefits in high immunological risk patients, despite increased infection and DSA risks.
  • The necessity and efficacy of induction therapy in low-to-moderate immunological risk kidney transplant recipients remain debatable.
  • Basiliximab appears to be a safer alternative with comparable outcomes to no induction in certain patient populations.

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