Induction Type and Outcomes for Kidney Graft and Patient Survival in Recipients with Prior Lung Transplantation in the United States

Abstract Background Induction immunosuppression regimens for kidney transplant in lung transplant recipients vary widely. We studied the impact of induction types for kidney-after-lung transplant recipients. Methods Using the SRTR database between 1994 and 2015, we studied outcomes of patients and kidney grafts for 330 kidney-after-lung transplant recipients for whom induction before kidney transplant included depletional (n=115), non-depletional (n=170) or no induction (steroids only) (n=45). We studied risk factors for recipient and graft survival using Cox proportional hazards model adjusted for kidney and lung induction, kidney donor type, dialysis status, recipient and donor ages, time from lung to kidney transplant, cause of lung disease, bilateral vs. single lung transplant, diabetes and HLA mismatches before kidney transplant, with transplant center as a random effect. Results There was no difference between groups in patient survival or death-censored kidney allograft survival. The one-year kidney acute rejection rates were 15.5 %, 7.14 % and 0% in depletional, non-depletional and no induction groups, respectively. In the Cox model for patient survival, living kidney donor recipients and bilateral lung transplant recipients were favorable predictors. For death-censored graft survival, kidney induction type did not predict graft survival. Results did not change when models only included recipients on tacrolimus and mycophenolate based maintenance. Conclusion Type of kidney induction did not influence patient or kidney graft survival following kidney transplant for those with previous lung transplants. No induction may be the preferred choice for kidney-after-lung transplant due to the lack of benefits of biologic induction in this large cohort.