Protocol Based Induction Therapy Improves Rejection Rates, Complications, and Transplant Event Costs in Adult Kidney Transplant Recipients

Introduction: Induction therapy is the cornerstone of early immunosuppression in kidney transplant recipients. However, the choice of induction agent based on donor and recipient characteristics is controversial. A number of transplant programs utilize the same induction agent in all patients; while other programs utilize a risk/benefit approach, prescribing less potent therapy in low immunologic risk patients and reserving potent induction therapy for high immunologic risk recipients. There are no studies comparing these approaches. Thus, the aim of this study was to assess the safety and efficacy of protocols designed to optimally prescribe induction therapy based on donor/ recipient risk compared to random therapy. Methods: This was a longitudinal cohort study that analyzed the safety and efficacy of induction therapy in patients that received protocol‐guided therapy delineating use based on donor/recipient risks (>20% HLA pre‐formed antibodies [PRA], cold ischemic time >24 hrs, or re‐transplant status were considered high immunologic risk and received T‐cell depleting agents [rATG]; all others received IL‐2 receptor blockers) compared to patients that received induction randomly as part of a RCT. Adult solitary kidney transplant recipients transplanted between 2005 and 2012 were included in this study. Data collection and analysis included sociodemographics, comorbidities, immunosuppression, and laboratory results. Outcomes included acute rejection, infections (BK, CMV, and composite), mean eGFR, and transplant event costs. Results: 1,176 patients were included, 978 received induction based on protocols, compared to 198 that received random induction as part of the RCT. Baseline characteristics were similar between groups, except for hypertension, re‐transplant, HLA mismatches, and warm ischemic time (Table 1). Univariate analysis demonstrated acute rejection rates between the protocol and random groups were 14% vs. 17%, (p=0.22), infection rates were 40% vs. 47%, (p=0.06), mean eGFRs were 58618 vs. 58619 mL/min, (p=0.45) and transplant event costs were $70.5k vs. $79.5k, respectively (p