The Current Trend of Induction and Maintenance Treatment in Patient of Different PRA Levels: A Report on OPTN/UNOS Kidney Transplant Registry Data.

Cai J, Terasaki PI.

Clinical Transplants 2010, Chapter 4

Abstract

We investigate the status of sensitization in kidney transplant recipients and analyze the trend of induction and maintenance therapy in patients of different PRA levels. Despite the fact of the decreased percentages of kidney transplant recipients with presensitization history, the mean PRA levels of all kidney recipients has been increasing in the last 7 years, which is possibly due to the introduction of more sensitive antibody testing techniques or the tendency for kidney allocation organization and clinicians to give priority to patients with elevated PRA once a compatible donor kidney becomes available. The percentage of patients with treated rejection episodes within one year post-transplant were significantly higher in sensitized patients (PRA = 50-100:14.3%, and PRA = 1-49%: 13.9%) than in non-sensitized patients (12.4%). Both 1- and 5-yr graft survival rates have improved in the last 10 years; this was more significant in high PRA patients. Thymoglobulin was the most commonly used induction agent in last 10 years. Its users increased from 10% to 46% in non-sensitized patients, from 12% to 57% in PRA = 1-49% patients, and from 19% to 63% in PRA = 50-100% patients. The users of Campath, IVIg, and Rituximab have been increasing and reached 16%, 20%, and 11% in highly sensitized patients. In the last 5 years, steroid-free patients were 33-36%, 30-37%, and 10-25% for patients with PRA levels of 0, 1-49, and 50-100 respectively. Almost 90% of patients were on Prograf at discharge. Myfortic users have been increasing since 2005 and it may soon replace MMF if long-term follow-up study confirms its safety and efficacy.