J. J. Lang1, M. John2, K. Schubauer1, Y. Yu3, E. Siskind4, R. Plews2, O. Ekwenna1, N. Koizumi3, J. Ortiz2 1University Of Toledo Medical Center, Urology And Transplantation, Toledo, OH, USA 2Albany Medical College, Kidney And Pancreas Transplant Program, Department Of Surgery, Albany, NY, USA 3George Mason University, Schar School Of Policy And Government, Arlington, VA, USA 4University Of Minnesota, Department Of Surgery, Minneapolis, MN, USA
Introduction:
Anti-thymocyte globulin (ATG) and Alemtuzumab are two induction agents predominantly used in kidney transplantation, but their comparative clinical efficacy has not been well established. This analysis aims to compare graft survival and other short-term outcomes in kidney transplant recipients (KTRs) receiving either ATG or Alemtuzumab induction therapy on a national level.
Methods:
A retrospective analysis of the United Network for Organ Sharing (UNOS) database between January 1, 2010 and May 31, 2021 was performed to compare outcomes of KTRs receiving either alemtuzumab or ATG induction regimens. Multi-organ transplants, living donor transplants, pediatric donor grafts and recipients less than 18 years of age were excluded form analysis. Primary outcomes included death censored graft and patient survival. Secondary outcomes included hospital length of stay (LOS), short term (12 month) acute rejection within 12 months and rejection occurring after 12 months, delayed graft function (DGF), CMV infection within the first year, re-admission, were analyzed and reported.
Results:
Data was collected from 91,036 ATG and 27,527 Alemtuzumab recipients. There was no significant difference in risk of graft failure within one year between ATG and Alemtuzumab (HR 0.974, 95% CI 0.869, 1.092, p=0.65). With regards to the secondary outcomes, ATG was associated with increased LOS (ATG – 5.72 vs. Alemtuzumab – 4.97 days, p<0.001), increased risk of acute rejection (HR 1.069, CI 1.016, 1.124 , p=0.010), higher likelihood of experiencing DGF (HR 1.093, 95% CI 1.012, 1.181, p=0.024) and CMV infection within the first year (HR 1.141, 95% CI 1.058, 1.230, p=0.001).
Conclusion:
The findings in this national retrospective analysis suggest that though there was no graft survival difference between ATG and Alemtuzumab, Alemtuzumab use was associated with better short-term outcomes in KTRs. ATG was associated with increased risk of LOS, acute rejection, and CMV following organ transplantation. Large scale randomized controlled trials are necessary to substantiate these findings