Induction Therapy in Elderly Kidney Transplant Recipients with Low Immunological Risk
Résumé
BACKGROUND: In nonimmunized patients, similar rejection rates are observed for patients who have undergone Thymoglobulin (ATG) or Basiliximab (BSX) therapy. Whilst ATG may improve Delayed Graft Function (DGF), it may also be associated with higher infection rates and malignancy risk. We compared survival and clinical outcomes in elderly recipients with low immunological risk according to their induction therapy. METHODS: We conducted a multicentric study on nonimmunized ≥q 65 years patients receiving a first kidney transplant between 2010 and 2017. The principal outcome was patient and graft survival. Secondary outcomes were cumulative probabilities of infection, first acute rejection episode, malignancy, de novo DSA, Post Transplant Diabetes (PTD), cardiac complications, eGFR, occurrence of DGF. Cox, logistic or linear statistical models were used depending on the outcome studied, and models were weighted on the propensity scores. RESULTS: 204 patients were included in the BSX group and 179 in the ATG group, with the average age 71.0 and 70.5 years respectively. Patient and graft survival at 3 years posttransplantation were 74% (95%CI from 65% to 84%) and 68% (95%CI from 60% to 78%) in ATG and BSX group respectively, without significant difference. Occurrence of PTD was significatively higher in BSX group (23% vs 15%, p = 0.04) due to higher trough levels of Tacrolimus on month 3 (9.48 vs 7.30 ng/ml, p = 0.023). There was no difference in other evaluated outcomes. CONCLUSION: In elderly recipients, ATG does not lead to poorer outcomes compared to BSX and could permit lower trough levels of Tacrolimus, thus reducing occurrence of PTD.