Impact of Induction Therapy on Preventing Early Acute Kidney Allograft Rejection: A Single-Center Experience Study

Acute rejection infrequently occurs among immunologically low-risk recipients within the first few weeks after transplantation, and the role of induction treatment in the frequency of acute rejection and graft loss remains debatable.

This retrospective study analyzed 208 kidney transplant recipients with low immunological risk, defined by living donor transplantation, no prior transplantation history, absence of preformed anti-HLA antibodies, and a negative lymphocyte crossmatch prior to transplantation. Demographic data, immunologic characteristics, and graft functions were analyzed concerning early acute rejection history.

Fifteen patients (7.2%) experienced acute rejection within two weeks post-transplantation. No correlation was found between the number of HLA mismatches and induction treatment with early acute rejection. The cumulative incidences of acute rejection in the no-induction and basiliximab groups were comparable at 7.8% and 6.4%, respectively. Donor age was markedly higher, and the tacrolimus trough level on the seventh day post-transplantation was significantly lower in the early acute rejection group; however, the significance was lost after adjustment. The incidence of graft loss was higher in the early acute rejection cohort than in the no-rejection cohort (33.3% vs. 3.1%, p<0.001). Early acute rejection was the only independent risk factor for graft failure (HR 10.286, CI 1.944-54.409, p=0.006).

Acute rejection within two weeks post-transplantation has been associated with suboptimal graft function in recipients with low immunological risk. Basiliximab does not provide additional advantages in preventing early acute rejection in patients with a low immunological risk on tacrolimus-based immunosuppression.