Induction type and outcomes for kidney graft and patient survival in recipients with prior lung transplantation in the United States

Samy Riad, Umesh Goswami, Scott Jackson, Marshall Hertz, Arthur Matas

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Induction immunosuppression regimens for kidney transplants in lung transplant recipients vary widely. We studied the impact of induction types for kidney after lung transplant recipients. METHODS: Using the Scientific Registry of Transplant Recipients database between 1994 and 2015, we studied outcomes of patients and kidney grafts for 330 kidney after lung transplant recipients for whom induction before kidney transplant included depletional (n = 115), non-depletional (n = 170), or no induction (steroids only; n = 45). We studied risk factors for recipient and graft survival using Cox proportional hazards model adjusted for kidney and lung induction, kidney donor type, dialysis status, recipient and donor ages, time from lung to kidney transplant, cause of lung disease, bilateral vs single lung transplant, diabetes, and human leukocyte antigen mismatches before kidney transplant, with transplant center as a random effect. RESULTS: There was no difference between groups in patient survival or death-censored kidney allograft survival. The 1-year kidney acute rejection rates were 15.5%, 7.14%, and 0% in depletional, non-depletional, and no induction groups, respectively. In the Cox model for patient survival, living kidney donor recipients and bilateral lung transplant recipients were favorable predictors. For death-censored graft survival, kidney induction type did not predict graft survival. Results did not change when models only included recipients on tacrolimus and mycophenolate based maintenance. CONCLUSIONS: The type of kidney induction did not influence patient or kidney graft survival following kidney transplants for those with previous lung transplants. No induction may be the preferred choice for kidney after lung transplant because of the lack of benefits from biologic induction in this large cohort.

Original languageEnglish (US)
Pages (from-to)157-164
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number2
DOIs
StatePublished - Feb 2020

Bibliographical note

Funding Information:
The authors have no conflict of interest to declare. The data reported here have been supplied by the Hennepin Healthcare Research Institute as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR or the United States government. This work was supported by the University of Minnesota Department of Medicine, which provided the funds to acquire the SRTR standard analysis file. The authors acknowledge Fairview Health Services for providing the statistical support needed for this project, and Alyson Coleman, a project specialist at the division of nephrology and hypertension for her editorial support.

Publisher Copyright:
© 2019 International Society for Heart and Lung Transplantation

Keywords

  • kidney after lung transplant
  • kidney graft survival
  • kidney induction
  • one-year hospitalization
  • patient survival

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