Outcomes of Primary Simultaneous Pancreas-kidney Transplants by Induction Agent in the United States

Adam Cerise; Tamer Shaker; Phuoc LeNguyen; Anant Dinesh; Karthik Ramanathan; Vanessa Humphreville; Scott Jackson; Raja Kandaswamy; Samy Riad

doi:10.1097/TXD.0000000000001412

Outcomes of Primary Simultaneous Pancreas-kidney Transplants by Induction Agent in the United States

Transplant Direct. 2022 Nov 17;8(12):e1412. doi: 10.1097/TXD.0000000000001412. eCollection 2022 Dec.

Authors

Adam Cerise¹, Tamer Shaker¹, Phuoc LeNguyen¹, Anant Dinesh¹, Karthik Ramanathan¹, Vanessa Humphreville¹, Scott Jackson², Raja Kandaswamy¹, Samy Riad^{3

4}

Affiliations

¹ Division of Transplant Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN.
² Complex Care Analytics, MHealth Fairview, Minneapolis, MN.
³ Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN.
⁴ Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.

Abstract

Long-term outcome data by induction type in simultaneous pancreas-kidney (SPK) is limited.

Methods: Utilizing the Scientific Registry of Transplant Recipients, we examined all primary SPK transplants between 2000 and 2020, excluding crossmatch-positive recipients. We grouped recipients according to induction regimen into 3 groups: rabbit anti-thymocyte globulin (r-ATG) (n = 5678), alemtuzumab (n = 1199), and interleukin-2 receptor antagonist (IL-2RA; n = 1593). We analyzed the 10-y recipient and composite (kidney and pancreas) graft survival using the Kaplan-Meier survival function. Cox-proportion hazard models were generated to examine the association between induction type, the 10-y recipient, and graft survival. Models were adjusted for recipient age, sex, ethnicity, HLA-mismatch, diabetes type, dialysis dependency, cold-ischemia time, local versus imported organs, panel reactive antibody, steroid maintenance, and Pancreas Donor Risk Index.

Results: r-ATG was associated with the lowest 1-y kidney and pancreas rejection rates compared with other agents (P < 0.001). In the univariable analysis, induction type was not associated with recipient (log-rank P = 0.11) or graft survival (log-rank P = 0.36). In the multivariable model for the composite graft survival, alemtuzumab use was associated with 22% increased kidney or pancreas graft loss compared with r-ATG (adjusted hazard ratio, 1.22; 95% confidence interval, 1.05-1.42), whereas IL-2RA use was not a predictor of graft survival. Induction type did not influence recipient survival in the adjusted model.

Conclusions: r-ATG use was associated with the lowest SPK rejection rates. Compared with r-ATG, alemtuzumab but not IL-2RA was associated with worse long-term death-censored SPK graft outcome. Our analysis supports the common use of r-ATG for induction in US primary SPK recipients.