In kidney transplantation, induction therapy is often selected based on perceived immunologic risk for acute rejection, commonly considering African American (AA) ethnicity, panel reactive antibody (PRA) levels > 20%, and retransplantation. Aims Compare post-transplant outcomes in African American kidney transplant recipients between two induction agents, rabbit anti-thymocyte globulin (rATG) and basiliximab and followed long-term. Methods This single-center retrospective study included 173 AA KTRs followed for a mean of 39.7 ± 26.3 months. Patients received induction with either rATG (n = 71, 41%) or basiliximab (n = 102, 59%). All recipients were maintained on calcineurin inhibitor–based triple immunosuppression. Backward stepwise regression was used to obtain final adjusted models, and time to graft loss was analyzed using Cox proportional hazards regression (STATA 15). Results There were no significant differences in overall graft survival (p = 0.75), or death censored graft survival (p=0.28), between the two induction groups. The incidence of first biopsy-proven acute rejection (BPAR) was similar (p = 0.14). Compared with basiliximab, rATG induction significantly increased the risk of viral infections (p = 0.019), bacterial infections (p = 0.025), and overall infections (p = 0.035). Infections were a risk factor for late graft loss (p = 0.039). Conclusion Among AA kidney transplant recipients, the use of depleting induction therapy with rATG did not confer benefit for graft or patient survival in the intermediate and long-term but was associated with a significantly higher risk of post-transplant infections. These findings suggest that the use of depleting antibody induction should be carefully balanced against infection risk and that risk stratification based solely on ethnicity should be reconsidered.
Tobar et al. (2026) studied this question.