Rabbit Antithymocyte Globulin vs Basiliximab Induction in ABO-Incompatible Kidney Transplantation: A Single-Center...

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• Rabbit antithymocyte globulin (rATG) is common for high-risk kidney transplants (KT).
• Comparative data for rATG vs. basiliximab in ABO-incompatible (ABOi) KTx is limited.
• The influence of ABO compatibility on induction agent effectiveness needs further study.

Purpose of the Study:

• To compare rATG and basiliximab induction in ABOi KTx.
• To assess if ABO compatibility modifies the outcomes of these induction strategies.

Main Methods:

• Retrospective single-center cohort study (2011-2020) of adult KTx recipients.
• Patients received rATG or basiliximab induction, stratified by ABO compatibility.
• Kaplan-Meier and Cox models analyzed patient survival, death-censored graft survival (DCGS), and rejection-free survival, with interaction analysis for ABO compatibility.

Main Results:

• Among 1546 KTx recipients, 285 were ABOi (69 rATG, 216 basiliximab).
• No significant differences in patient survival, rejection-free survival, or infection hospitalization between induction groups.
• A significant interaction between induction strategy and ABO compatibility was found for DCGS (P=.031).
• Cytomegalovirus viremia was more frequent with rATG.

Conclusions:

• In ABOi KTx, rATG improved DCGS versus basiliximab, with similar patient survival and infectious complications.
• The impact of induction on graft survival differs based on ABO compatibility.
• A risk-adapted approach to induction therapy in KTx is supported.