DOI: 10.4103/ijn.ijn_84_23 ISSN:

Role of Induction in a Haplomatch, Related, Low-risk, Living-donor Kidney Transplantation with Triple Drug Immunosuppression: A Single-center Study

Pranaw K. Jha, Shyam B. Bansal, Reetesh Sharma, Sidharth K. Sethi, Dinesh Bansal, Ashish Nandwani, Ajay Kher, Dinesh K. Yadav, Ashwini Gadde, Amit K. Mahapatra, Abhyuday S. Rana, Puneet Sodhi, Manish Jain, Vijay Kher
  • Nephrology
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Abstract

Introduction:

The role of induction in low-risk, living-donor kidney transplants being treated with tacrolimus, mycophenolate mofetil, and prednisolone is debatable.

Methods:

This was a retrospective study that consisted of patients undergoing living kidney transplantation between February 2010 and June 2021 with a related haplomatch donor, with maintenance immunosuppression of tacrolimus, mycophenolate mofetil, and prednisolone. High-risk transplants, such as second or more transplants, immunologically incompatible transplants, and steroid-free transplants, were excluded.

Patients were divided into three groups:

no induction, basiliximab induction, and thymoglobulin induction, and the outcomes of all three were compared.

Results:

A total of 350 transplants were performed. There was a significant difference in the recipient sex distribution (P = 0.0373) and the number of preemptive transplants (P = 0.0272) between the groups. Other parameters were comparable. Biopsy-proven acute rejection (BPAR) was significantly less frequent in the thymoglobulin group than in the no-induction (5.3% vs. 17.5%; P = 0.0051) or basiliximab (5.3% vs. 18.8%; P = 0.0054) group. This persisted even after we performed multivariate regression analysis (thymoglobulin vs. no-induction group, P = 0.0146; thymoglobulin vs. basiliximab group, P = 0.0237). There was no difference in BPAR between the basiliximab and no-induction groups. There were no differences in other outcomes between the groups.

Conclusions:

In a low-risk haplomatch, related, living-donor kidney transplant on tacrolimus, mycophenolate mofetil, and prednisolone, BPAR was significantly lower with thymoglobulin as opposed to no induction or basiliximab induction with a similar short-term patient and death-censored graft survival and infection rates. Basiliximab did not provide any benefit over no induction.

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