G8(W)
DOES CAMPATH INDUCTION MITIGATE THE EFFECTS OF DELAYED GRAFT
FUNCTION?
Chan, K, Goodall, D, Galliford, J, Charif, R, Duncan, N, Papalois, V, Hakim, N, A
McLean, A, Taube, D
Imperial College Kidney and Transplant Centre, Hammersmith Hospital, London, United
Kingdom
Despite recent UNOS data showing that induction with Campath is associated with the lowest risk of renal allograft failure, the effect of delayed graft function [DGF] in patients receiving
Campath induction is unknown.
We report the effect of DGF in a cohort of 500 consecutive kidney allografts [184f, 316m; mean age 48.2 years] transplanted from November 2005 in our unit receiving Campath induction
[30mg iv perioperatively], a steroid sparing regime [prednisolone 60 mg/d, days 0-3; 30 mg/d, days 4-6, then stopped] and low dose Tacrolimus monotherapy maintenance [0.1mg/kg/day, target 5-8 ng/mL].
DGF was defined as the need for dialysis after transplantation.
DGF occurred in 91/500 [18.2%] recipients.
Multivariable analysis demonstrated that every hour of cold ischemia time [CIT] increased the risk of DGF by 10% [OR 1.1; p=0.025; Logistic regression]. CIT together with recipient age
[OR 1.06 per year; p=0.036] were strong predictors for DGF.
5 year patient survival was similar in the 2 groups [DGF+ 92.3%, DGF- 94.5%] whereas allograft survival was inferior in the DGF+ group [71.3% vs 93.5%; Logrank p<0.0001].
DGF was associated with a higher incidence of rejection [30.9% vs 25.9%; p=0.0446]. After adjusting for the effect of rejection and donor type, DGF was associated with a 4.8 fold increased risk of graft loss [HR 4.8; 95%CI:2.0,11.9; p=0.001; Weibull survival model with
Lexis expansion].
Allograft function [MDRD eGFR] in the DGF+ group was 15.1 ml/min/1.73m2 [95%CI: -11.1,
-19.1 p<0.001] lower before rejection than in the DGF- group. Whilst both groups experienced reduction in eGFR after rejection, the fall in eGFR in the DGF+ group was 6.2 ml/min greater than in the DGF- group [95%CI -1.0,-12.6; p<0.001; Mixed-effect model].
This is the first published study showing that DGF is associated with an increased risk of graft failure, rejection and impaired allograft function in patients receiving Campath induction.