Outcome of Different Induction Therapies in Living Donor Renal Transplant in Indian Population: A Single Center Experience

BACKGROUND AND OBJECTIVES: Induction therapy with interleukin-2 receptor antagonist (IL2-RA) is recommended as a first line agent in living donor renal transplantation (LRT). However, comparative outcomes of induction therapy remains controversial in Indian LRT population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: A single center (Medanta Medicity, Gurgaon, India) dataset was retrospectively studied for patients receiving LRT from 2010 to 2014 (N=901) to compare effectiveness of IL2-RA to other induction options (no-induction and rabbit anti-thymocyte globulin [r-ATG]). IL2-RA and no-induction were chosen for immunologically low risk patients. RATG was primarily given to the recipient with PRA>20% and HLA mismatch > 5 antigen out of 6. The main outcomes were the risk of acute rejection at one-year and overall allograft failure (graft failure or death) post-transplantation through the end of follow-up. RESULTS: Donor, recipient and transplant characteristics of three induction categories are shown in Table 1. Similar Kaplan Meier curves for overall graft survivals were observed among induction categories, shown Figure1. Rejection rate was higher in no-induction and IL2-RA groups (~25%) compared to r-ATG induction. On univariate Cox analysis, compared to no-induction therapy, overall allograft failure was similar among induction categories. Most of the rejections were borderline or Banff Type I acute cellular rejections. CONCLUSIONS: Compared to no-induction therapy, IL2-RA induction was not associated with better outcomes in Indian LRT recipients. r-ATG appears to be an acceptable and possibly the preferred induction alternative for IL2-RA in high rejection risk Indian patients.