David J T et al. – This study determined the impact of cytolytic induction therapy versus interleukin–2 receptor antibody (IL–2RA) induction therapy on acute rejection, graft loss, and death in African–American (AA) kidney transplant (KTX) recipients. The study demonstrated that the cytolytic versus IL–2RA induction therapy reduces the risk of rejection, graft loss, and death in adult AA KTX recipients, particularly in those who are sensitized, receive public insurance, develop delayed graft function, or undergo steroid withdrawal.

Methods

• Data from the US transplant registry from January 1, 2000, to December 31, 2009, in adult solitary AA KTX recipients, with at least 5 years of follow–up were analyzed.
• Outcomes of acute rejection, graft loss, and mortality were assessed using multivariable logistic and Cox regression models.

Results

• Of the 25,084 adult AA solitary KTX recipients, 16,927 (67.5%) received cytolytic induction and 8157 (32.5%) received IL–2RA induction therapy.
• The use of cytolytic induction therapy reduced the risk of acute graft rejection by 32% (Odds ratio: 0.68, 0.62–0.75), graft loss by 9% (HR: 0.91, 0.86–0.97), and death by 12% (Hazard ratio [HR]: 0.88, 0.83–0.94), following adjustments for recipient sociodemographic, donor, and transplant characteristics.
• In particular, cytolytic induction therapy substantially improved outcomes for those with significant effect modifiers, including public insurance, panel reactive antibody, delayed graft function, and steroid withdrawal.