Abstract
The choice of induction immunosuppression can affect several outcomes after kidney transplant (KTx). We aimed to evaluate infectious and malignant complications between alemtuzumab and basiliximab in elderly KTx recipients. Patients ≥ 65 years old who received alemtuzumab or basiliximab induction for their primary KTx from 2006 – 2018 were included.
Highlights
[1] Interleukin-2 receptor antagonists (IL2-RA) are recommended by the 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for kidney transplant recipients as a first line induction therapy, while lymphocyte-depleting agents’ anti-thymocyte globulin or alemtuzumab are recommended for patients at high immunologic risk. [2]
The Organ Procurement Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR) 2018 Annual Data Report indicates that the proportion of patients age 65 years and older on the kidney transplant waiting list continues to increase, and comprises nearly 25% of the national kidney waitlist.[11]
[4] As such, elderly renal transplant recipients may be more prone to infection and malignancy after transplantation with a lower risk of acute allograft rejection, especially in the presence of lymphocyte depleting induction immunosuppression. [5-7]
Summary
The choice of induction immunosuppression, utilized at the time of organ transplantation, can affect post-transplant outcomes such as acute rejection and infection. [1] Interleukin-2 receptor antagonists (IL2-RA) are recommended by the 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for kidney transplant recipients as a first line induction therapy, while lymphocyte-depleting agents’ anti-thymocyte globulin or alemtuzumab are recommended for patients at high immunologic risk. [2]As life expectancy in the general population continues to increase, healthcare professionals are improving the management of chronic disease states known to cause chronic kidney disease and subsequently delaying the need for dialysis and kidney transplantation. The Organ Procurement Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR) 2018 Annual Data Report indicates that the proportion of patients age 65 years and older on the kidney transplant waiting list continues to increase, and comprises nearly 25% of the national kidney waitlist.[11]. Despite these demographic changes, kidney transplantation remains a treatment option for elderly patients with end stage kidney disease conferring a survival advantage compared to those who remain on long-term dialysis.[12]. In the elderly population there is a decreased capacity of antigen-recognition and T-cell differentiation resulting in the host’s inability to mount a complete immune response. [4] As such, elderly renal transplant recipients may be more prone to infection and malignancy after transplantation with a lower risk of acute allograft rejection, especially in the presence of lymphocyte depleting induction immunosuppression. [5-7]
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