Background We retrospectively compared two distinct dual-induction strategies in pediatric kidney transplantation. Methods Patients transplanted at our center prior to 15 February 2020 were scheduled to receive three doses of rabbit antithymocyte globulin (rATG; 1.0 mg/kg/dose) along with two doses of basiliximab ( N = 42), while patients transplanted thereafter were scheduled to receive a single dose of rATG with two doses of basiliximab ( N = 50). Both intent-to-treat (ITT) groups were scheduled to receive reduced tacrolimus dosing, mycophenolate acid, and early corticosteroid withdrawal. The two primary endpoints were first biopsy-proven acute rejection (BPAR) and any viral viremia. In allowing for a similar follow-up period, all clinical outcomes were compared during the first 24 months (mo) post-transplant. In addition, multivariable analyses were performed adjusting for the propensity to belong to the single-dose ITT rATG group. Results Median follow-up in both groups was 24 mo post-transplant. In the single-dose ITT rATG group, a higher proportion of patients developed a first BPAR P = 0.10; 34.0% (17/50) vs. 21.4% (9/42), while a lower proportion developed any viral viremia P = 0.08; 28.0% (14/50) vs. 47.6% (20/42). Two baseline variables were associated with a significantly higher propensity to belong to the single-dose ITT rATG group: older recipient age ( P = 0.02) and longer WIT ( P = 0.02). After adjusting for the propensity score in multivariable analyses, the single-dose ITT rATG group remained associated with a higher first BPAR rate ( P = 0.06) but was no longer associated with the rate of viral viremia ( P = 0.30). Estimated graft survival at 24 mo post-transplant (combined across both groups) was 92.9% ± 2.8%. Conclusions A lower rate of first BPAR but a somewhat higher rate of viral infection was observed in the three-dose ITT rATG group. These study results support the use of tailored induction protocols to optimize effective immunosuppression while minimizing adverse effects in pediatric kidney transplantation.
Ciancio et al. (Tue,) studied this question.