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

IF 1.6 4区医学 Q4 IMMUNOLOGY

Transplant immunology Pub Date : 2025-02-11 DOI:10.1016/j.trim.2025.102198

Emmanuel Aydin-Ghormoz , Jorge Ortiz , Kathryn Schubauer , Naoru Koizumi , Meng-Hao Li , Geovani Faddoul

{"title":"Induction outcomes in adult kidney transplantation: Two decades of UNOS data analysis","authors":"Emmanuel Aydin-Ghormoz , Jorge Ortiz , Kathryn Schubauer , Naoru Koizumi , Meng-Hao Li , Geovani Faddoul","doi":"10.1016/j.trim.2025.102198","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Material and methods</h3><div>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.</div></div><div><h3>Results</h3><div>Alemtuzumab correlated with increased graft failure in deceased-donor and living-donor kidney transplants (HR 1.075 [1.015–1.138] <em>p</em> = 0.013 and HR 1.096 [1.011–1.188] <em>p</em> = 0.026 respectively) and with increased mortality in living-donor kidney transplants (HR 1.215 [1.107–1.332] <em>p</em> < 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] <em>p</em> < 0.001 and HR = 0.88 [0.83–0.93] <em>p</em> < 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"89 ","pages":"Article 102198"},"PeriodicalIF":1.6000,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplant immunology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0966327425000267","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"IMMUNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

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.

Material and methods

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.

Results

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.

Conclusions

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.

查看原文本刊更多论文

成人肾移植的诱导结果：UNOS二十年的数据分析

在美国，92%的肾移植受者接受了诱导治疗。本分析评估了诱导免疫抑制对移植失败、患者死亡率和住院时间等结果的影响。材料和方法对2000年1月至2022年6月接受肾移植的成人UNOS数据库进行回顾性分析。分析的重点是诱导方案，包括抗胸腺细胞球蛋白（ATG）、阿仑单抗和巴利昔单抗，以及钙调磷酸酶抑制剂、霉酚酸酯加或不加强的松的维持免疫抑制。采用多变量逻辑回归来确定与结果相关的因素。Kaplan-Meier产品极限法评估生存率。结果salemtuzumab与死亡供肾和活体肾移植中移植失败增加相关（HR分别为1.075 [1.015-1.138]p = 0.013， HR为1.096 [1.011-1.188]p = 0.026），与活体肾移植死亡率增加相关(HR为1.215 [1.107-1.332]p <；0.001)。在死亡供者和活体供者肾移植中，类固醇维持与较少的急性排斥反应相关(HR = 0.875 [0.84-0.90] p <；0.001, HR = 0.88 [0.83-0.93] p <；0.001分别)。阿仑单抗组CMV发生率较低。与ATG相比，阿仑单抗诱导与死亡供肾移植和活体供肾移植的住院时间较短，活体供肾移植的首次住院时间较长相关。结论salemtuzumab与更短的住院时间、更少的再住院和更少的CMV感染相关。然而，在成人肾移植受者中，它与较高的移植物衰竭和死亡率相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Transplant immunology 医学-免疫学

CiteScore

2.10

自引率

13.30%

发文量

198

审稿时长

48 days

期刊介绍： Transplant Immunology will publish up-to-date information on all aspects of the broad field it encompasses. The journal will be directed at (basic) scientists, tissue typers, transplant physicians and surgeons, and research and data on all immunological aspects of organ-, tissue- and (haematopoietic) stem cell transplantation are of potential interest to the readers of Transplant Immunology. Original papers, Review articles and Hypotheses will be considered for publication and submitted manuscripts will be rapidly peer-reviewed and published. They will be judged on the basis of scientific merit, originality, timeliness and quality.