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Cytolytic Induction Therapy Improves Clinical Outcomes in African-American Kidney Transplant Recipients
David J Taber, John McGillicuddy, Charles Bratton, Satish Nadig, Derek Dubay, Prabhakar Baliga
MUSC, Charleston, SC

OBJECTIVE(S): African-Americans (AAs) are substantially underrepresented in clinical trials; thus, controversy remains regarding the optimal choice of peri-operative antibody induction in kidney transplant (KTX).
METHODS: Analysis of US registry data from 1990-2009, comparing the impact of peri-operative cytolytic vs. IL-2 receptor antibody (IL-2RA) induction therapy on long-term outcomes in adult solitary AA KTX recipients. Multivariable logistic and Cox regression were utilized to assess the outcomes of acute rejection, graft loss and mortality, with interaction terms to assess for effect modification.
RESULTS: 25,084 adult AAs receiving solitary KTX were included, 16,927 (67.5%) received cytolytic induction and 8,157 (32.5%) received IL-2RA induction. After adjustment for recipient sociodemographics, donor and transplant characteristics (31 variables), the use of cytolytic induction therapy reduced the risk of acute rejection by 32% (OR 0.68, 0.61-0.74), graft loss by 9% (HR 0.91, 0.86-0.97) and death by 12% (HR 0.88, 0.82-0.96). In particular, cytolytic induction substantially improved outcomes for those with clinically relevant modifiers, including public insurance, panel reactive antibody (PRA), delayed graft function (DGF), cold ischemic time (CIT), donor non-AA and steroid withdrawal (Figure).
CONCLUSIONS: These data make a strong case to standardize cytolytic induction therapy in AA kidney recipients as it reduces the risk of rejection, graft loss and death in adult AA KTX recipients, particularly in those that are sensitized (PRA>20%), receive public insurance, develop DGF or undergo steroid withdrawal.

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