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Lymphocyte depletion and risk of acute rejection in renal transplant recipients at increased risk for delayed graft function.

Publication ,  Journal Article
Ravindra, KV; Sanoff, S; Vikraman, D; Zaaroura, A; Nanavati, A; Sudan, D; Irish, W
Published in: Am J Transplant
March 2019

Delayed graft function (DGF) is a risk factor for acute rejection (AR) in renal transplant recipients, and KDIGO guidelines suggest use of lymphocyte-depletion induction when DGF is anticipated. We analyzed the United Network for Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) database to assess the impact of induction immunosuppression on the risk of AR in deceased kidney recipients based on pretransplant risk of DGF using a validated model. Recipients were categorized into 4 groups based upon the induction immunosuppression: (1) Rabbit anti-thymocyte globulin (rATG); (2) Alemtuzumab (C1H); (3) IL2-receptor antagonists (IL2-RA; basiliximab or daclizumab), and (4) No antibody induction. The primary endpoint for analysis was a composite endpoint of treated AR or graft failure by 1-year posttransplantation. Compared to no antibody induction, rATG and C1H had consistently lower adjusted odds of the composite endpoint across all risk strata for DGF risk, whereas IL2-Ra was associated with increased adjusted odds of the composite endpoint with increasing DGF risk. When the induction agents were compared, rATG and C1H were associated with decreasing adjusted odds for the composite endpoint with increasing risk of DGF, especially at the higher risk spectrum of DGF. Consideration must be given to use of lymphocyte-depletion induction when the anticipated risk of DGF is increased.

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Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

March 2019

Volume

19

Issue

3

Start / End Page

781 / 789

Location

United States

Related Subject Headings

  • Young Adult
  • Transplant Recipients
  • Surgery
  • Risk Factors
  • Prognosis
  • Postoperative Complications
  • Middle Aged
  • Male
  • Lymphocyte Depletion
  • Kidney Transplantation
 

Citation

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Ravindra, K. V., Sanoff, S., Vikraman, D., Zaaroura, A., Nanavati, A., Sudan, D., & Irish, W. (2019). Lymphocyte depletion and risk of acute rejection in renal transplant recipients at increased risk for delayed graft function. Am J Transplant, 19(3), 781–789. https://doi.org/10.1111/ajt.15102
Ravindra, Kadiyala V., Scott Sanoff, Deepak Vikraman, Ahmad Zaaroura, Aditya Nanavati, Debra Sudan, and William Irish. “Lymphocyte depletion and risk of acute rejection in renal transplant recipients at increased risk for delayed graft function.Am J Transplant 19, no. 3 (March 2019): 781–89. https://doi.org/10.1111/ajt.15102.
Ravindra KV, Sanoff S, Vikraman D, Zaaroura A, Nanavati A, Sudan D, et al. Lymphocyte depletion and risk of acute rejection in renal transplant recipients at increased risk for delayed graft function. Am J Transplant. 2019 Mar;19(3):781–9.
Ravindra, Kadiyala V., et al. “Lymphocyte depletion and risk of acute rejection in renal transplant recipients at increased risk for delayed graft function.Am J Transplant, vol. 19, no. 3, Mar. 2019, pp. 781–89. Pubmed, doi:10.1111/ajt.15102.
Ravindra KV, Sanoff S, Vikraman D, Zaaroura A, Nanavati A, Sudan D, Irish W. Lymphocyte depletion and risk of acute rejection in renal transplant recipients at increased risk for delayed graft function. Am J Transplant. 2019 Mar;19(3):781–789.
Journal cover image

Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

March 2019

Volume

19

Issue

3

Start / End Page

781 / 789

Location

United States

Related Subject Headings

  • Young Adult
  • Transplant Recipients
  • Surgery
  • Risk Factors
  • Prognosis
  • Postoperative Complications
  • Middle Aged
  • Male
  • Lymphocyte Depletion
  • Kidney Transplantation