Outcomes of Kidney Allograft and Recipient Survival After Liver Transplantation by Induction Type in the United States.

There are several choices for induction immunosuppression in kidney-after-liver transplantation. We examined the impact of induction type on kidney graft and patient survival in kidney-after-liver recipients. We utilized the Scientific Registry of Transplant Recipients (SRTR) database and included patients transplanted between 1/1/2000 and 7/31/2017 to study kidney graft and patient outcomes of all kidney-after-liver transplant recipients in the United States. We only included those who were discharged on tacrolimus and mycophenolate with or without steroids and who had a negative crossmatch prior to kidney engraftment. We grouped recipients by kidney induction type into three groups: depletional (N=550), non-depletional (n=434), and no antibody induction (n=144). We studied patient and kidney allograft survival using Cox PH regression, with transplant center included as a random effect. Models were adjusted for liver induction regimen, recipient and donor age, gender, Human Leukocyte Antigen (HLA) mismatches, payor type, live-donor kidney transplant, dialysis status, time from liver engraftment, hepatitis C status, and the presence of diabetes mellitus at time of kidney transplant and transplant year. Six-month and one-year rejection rates did not differ between groups. In the multivariable models, as compared to no induction, neither depletional nor non-depletional induction was associated with improved recipient or graft survival. Depletional induction at the time of liver transplantation was associated with worse patient survival after kidney transplant [HR 1.71, 95%C.I. (1.09, 2.67), P 0.02]. Live-donor kidney transplantation was associated with a 48.1% improved graft survival [HR 0.52, 95%C.I. (0.33, 0.82), P 0.00]. In conclusion, in the settings of a negative crossmatch and maintenance with tacrolimus and mycophenolate, induction use was not associated with a patient or graft survival benefit in kidney after liver transplants.