Outcomes in live renal allograft transplants with different modalities of induction: A hospital-based retrospective study in Odisha

Abstract

Introduction: The immunosuppressant regimen after kidney transplantation typically includes initial induction therapy followed by a maintenance regimen. The induction therapy was introduced with the aim of reducing acute rejections. A retrospective study was conducted to compare the outcomes in patients with different modalities of induction. Materials and Methods: This is a hospital-based retrospective study where 148 patients who have undergone live renal allograft transplantation at SCB Medical College and Hospital from March 2012 to February 2019 were included in the study. All cases included were crossmatch negative, ABO-compatible live renal allograft transplantations. All patients received tacrolimus, mycophenolate sodium, and steroids. Induction therapy varied depending on immunological risk and changes in protocol over time. Basiliximab, anti-T-lymphocyte globulin (ATLG), and anti-thymocyte globulin (ATG) were given in 56, 21, and 21 patients, respectively, and no induction therapy in 50 patients. All patients with an acute rise in serum creatinine and without an obvious cause of graft dysfunction were subjected to renal biopsy. The incidence of acute rejection, patient survival, and graft survival was calculated from the follow-up records and compared among patients receiving different induction therapies. Results: In the high-risk category patients, 31%, 20%, and 18.2% of patients (P = 0.6) and in the low risk category, 37%, 27.3%, and 20% of patients (P = 0.6) had acute rejections in basiliximab, ATLG, and ATG group, respectively. The patient survival at 1 year was 79.3%, 70%, and 81.8% in high-risk group patients (P = 0.84) and 88.9%, 81.8%, and 80% in low-risk group patients (P = 0.88) in the basiliximab, ATLG, and ATG groups, respectively. The graft survival at 2 years was 96.6%, 90%, and 90.9% in high-risk group patients (P = 0.32) and 88.9%, 90.9%, and 90% in low-risk group patients (P = 0.65) in the basiliximab, ATLG, and ATG groups, respectively. Conclusion: In the low-risk group, the use of different modalities of induction does not have any advantage over no induction therapy in reducing the incidence of acute rejection, or improving patient and graft survival. In the high-risk group, all the induction therapies used lead to similar outcomes and none show any advantage over the other in terms of statistical significance. However, patients who received ATLG or ATG have an increased incidence of septicemia as compared to basiliximab and no induction group.

Keywords

• anti-thymocyte globulin
• anti-t-lymphocyte globulin
• basiliximab
• induction
• kidney transplantation
• rejection
• survival