Increased Risk of Rejection after Basiliximab Induction in Sensitized Kidney Transplant Recipients without Pre-Existing Donor-Specific Antibodies - a Retrospective Study - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Transplant International Année : 2019

Increased Risk of Rejection after Basiliximab Induction in Sensitized Kidney Transplant Recipients without Pre-Existing Donor-Specific Antibodies - a Retrospective Study

Annabelle Goumard
  • Fonction : Auteur
Elodie Bailly
Elodie Miquelestorena-Standley
Barbara Proust
  • Fonction : Auteur
Hélène Longuet
  • Fonction : Auteur
Lise Binet
  • Fonction : Auteur
Christophe Baron
  • Fonction : Auteur
Jean-Michel Halimi
Matthias Buchler
  • Fonction : Auteur
Philippe Gatault

Résumé

Depleting induction therapy is recommended in sensitized kidney transplant recipients (KTRs), though the detrimental effect of nondonor-specific anti-HLA antibodies is not undeniable. We compared the efficacy and safety of basiliximab and rabbit anti-thymocyte globulin (rATG) in sensitized KTRs without pre-existing donor-specific antibodies (DSAs). This monocentric retrospective study involved all sensitized KTR adults without pre-existing DSAs (n = 218) who underwent transplantation after June 2007. Patients with basiliximab and rATG therapy were compared for risk of biopsy-proven acute rejection (BPAR) and a composite endpoint (BPAR, graft loss and death) by univariate and multivariate analysis. Patients with basiliximab (n = 60) had lower mean calculated panel reactive antibody than those with rATG (n = 158; 23.7 ± 24.2 vs. 63.8 ± 32.3, P < 0.0001) and more often received a first graft (88% vs. 54%, P < 0.0001) and a transplant from a living donor (13% vs. 2%, P = 0.002). Risks of BPAR and of reaching the composite endpoint were greater with basiliximab than rATG [HR = 3.63 (1.70-7.77), P = 0.0009 and HR = 1.60 (0.99-2.59), P = 0.050, respectively]. Several adjustments did not change those risks [BPAR: 3.36 (1.23-9.16), P = 0.018; composite endpoint: 1.83 (0.99-3.39), P = 0.053]. Infections and malignancies were similar in both groups. rATG remains the first-line treatment in sensitized KTR, even in the absence of pre-existing DSAs.

Dates et versions

hal-03158794 , version 1 (04-03-2021)

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Citer

Annabelle Goumard, Bénédicte Sautenet, Elodie Bailly, Elodie Miquelestorena-Standley, Barbara Proust, et al.. Increased Risk of Rejection after Basiliximab Induction in Sensitized Kidney Transplant Recipients without Pre-Existing Donor-Specific Antibodies - a Retrospective Study. Transplant International, 2019, 32 (8), pp.820-830. ⟨10.1111/tri.13428⟩. ⟨hal-03158794⟩
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