Impact of Lymphocyte Depleting Antibody(LDA) On Rate of Acute Rejection (AR) in Patients With Delayed Graft Function (DGF).

Abstract

Introduction: DGF impacts AR & graft survival in kidney transplantation (KTx). The KDIGO guideline suggest use of LDI when DGF is likely; but there is no robust data. The impact of LDI on risk of AR in patients with&without DGF was evaluated using OPTN registry. Methods: Adults receiving cadaver kidneys between 2002-11 were studied. Treated AR at 12 months post-KTx was analyzed per known risk factors (RFs) including recipient race, HLA 5/6 antigen mismatch, repeat transplant, ABOi, PRA >0%, ECD organ, cold time > 24 hours and DGF. Multivariable logistic regression model was fit to the data to evaluate whether the incidence of AR in patients with and without DGF is differentially impacted by the use of different induction strategies: No induction, Thymoglobulin(THY), alemtuzumab(C1H) and IL-2 receptor antagonists(IL2-Ra). Results: 73,984 patients were included. RFs by antibody induction are presented in Table 1. Odds of AR was significantly higher in patients who had DGF vs no DGF (Adjusted OR [aOR] =1.95; 95% CI=1.85-2.05), independent of known RFs for AR.Table: No Caption available.However, the impact of DGF was differentially affected by AI strategy (two-way interaction: p<0.001), represented graphically in Figure 1. Adjusted incidence of AR was similar in all groups of patients who had no DGF. In DGF group, AR was significantly lower in THY or C1H vs no induction (aOR=0.65; 95% CI=0.59-0.73 and aOR=0.72; 95% CI=0.60-0.85, respectively) while the incidence of AR remained similar in IL2-Ra vs no induction (aOR=1.12; 95%CI 0.99-1.26).Figure: No Caption available.Conclusion: DGF is an important risk factor for AR. The use of LDI significantly reduces the risk of AR in adult deceased donor renal transplant recipients who develop DGF. We recommend the routine use of LDI when the anticipated risk of DGF is high.