{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T22:00:00Z","timestamp":1780437600575,"version":"3.54.1"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T00:00:00Z","timestamp":1694217600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T00:00:00Z","timestamp":1694217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002345","name":"Eberhard Karls Universit\u00e4t T\u00fcbingen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002345","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Nephrol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The choice of induction therapy in kidney transplantation is often non-standardized and centre-specific. Clinicians can choose between depleting and non-depleting antibodies, which differ in their immunosuppressive capacity and the concomitant risk of infection. We herein present a standardized risk-stratified algorithm for induction therapy that might help to balance the risk of rejection and\/or serious infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prior to kidney transplantation, patients were stratified into low-risk, intermediate-risk or high-risk according to our protocol based on immunologic risk factors. Depending on their individual immunologic risk, patients received basiliximab (low risk), antithymocyte globulin (intermediate risk) or low-dose alemtuzumab (high risk) for induction therapy. We analysed the results after 3\u00a0years of implementation of our risk-stratified induction therapy protocol at our kidney transplant centre.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between 01\/2017 and 05\/2020, 126 patients were stratified in accordance with our protocol (low risk\/intermediate risk\/high risk: 69 vs. 42 vs. 15 patients). The median follow-up time was 1.9 [1.0\u20132.5] years. No significant difference was observed in rejection rate and allograft survival (low risk\/intermediate risk\/high risk: 90.07% vs. 80.81% vs. 100% after 3 years (p\u2009&gt;\u20090.05)) among the groups. The median eGFR at follow-up was (low risk\/intermediate risk\/high risk) 47 [33\u201358] vs 58 [46\u201376] vs 44 [22\u201355] ml\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      . Although the rate of viral and bacterial infections did not differ significantly, we observed a higher rate of opportunistic fungal infections with alemtuzumab induction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our strategy offers facilitated and individualized choice of induction therapy in kidney transplantation. We propose further evaluation of our algorithm in prospective trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40620-023-01746-1","type":"journal-article","created":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T07:02:32Z","timestamp":1694242952000},"page":"2133-2138","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Standardized, risk-adapted induction therapy in kidney transplantation"],"prefix":"10.1093","volume":"36","author":[{"given":"Felix","family":"Eisinger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"M\u00fchlbacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ario","family":"Na","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina","family":"Althaus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio","family":"Nadalin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas L.","family":"Birkenfeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Heyne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Guthoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,9,9]]},"reference":[{"issue":"Suppl 3","key":"1746_CR1","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1111\/j.1600-6143.2009.02834.x","volume":"9","author":"Kidney Disease: Improving Global Outcomes Transplant Work G","year":"2009","unstructured":"Kidney Disease: Improving Global Outcomes Transplant Work G (2009) KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 9(Suppl 3):S1-155. https:\/\/doi.org\/10.1111\/j.1600-6143.2009.02834.x","journal-title":"Am J Transplant"},{"issue":"1","key":"1746_CR2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004759.pub2","volume":"1","author":"P Hill","year":"2017","unstructured":"Hill P, Cross NB, Barnett AN, Palmer SC, Webster AC (2017) Polyclonal and monoclonal antibodies for induction therapy in kidney transplant recipients. Cochrane Database Syst Rev 1(1):CD004759. https:\/\/doi.org\/10.1002\/14651858.CD004759.pub2","journal-title":"Cochrane Database Syst Rev"},{"issue":"16","key":"1746_CR3","doi-asserted-by":"publisher","first-page":"1736","DOI":"10.1056\/NEJMc0805714","volume":"359","author":"DC Brennan","year":"2008","unstructured":"Brennan DC, Schnitzler MA (2008) Long-term results of rabbit antithymocyte globulin and basiliximab induction. N Engl J Med 359(16):1736\u20131738. https:\/\/doi.org\/10.1056\/NEJMc0805714","journal-title":"N Engl J Med"},{"issue":"1","key":"1746_CR4","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1186\/s12882-020-01767-z","volume":"21","author":"M Guthoff","year":"2020","unstructured":"Guthoff M, Berger K, Althaus K, Muhlbacher T, Bakchoul T, Steurer W et al (2020) Low-dose alemtuzumab induction in a tailored immunosuppression protocol for sensitized kidney transplant recipients. BMC Nephrol 21(1):178. https:\/\/doi.org\/10.1186\/s12882-020-01767-z","journal-title":"BMC Nephrol"},{"issue":"10","key":"1746_CR5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0240929","volume":"15","author":"J Boucquemont","year":"2020","unstructured":"Boucquemont J, Foucher Y, Masset C, Legendre C, Scemla A, Buron F et al (2020) Induction therapy in kidney transplant recipients: description of the practices according to the calendar period from the French multicentric DIVAT cohort. PLoS ONE 15(10):e0240929. https:\/\/doi.org\/10.1371\/journal.pone.0240929","journal-title":"PLoS ONE"},{"issue":"Suppl 2","key":"1746_CR6","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1111\/ajt.16502","volume":"21","author":"A Hart","year":"2021","unstructured":"Hart A, Lentine KL, Smith JM, Miller JM, Skeans MA, Prentice M et al (2021) OPTN\/SRTR 2019 annual data report: kidney. Am J Transplant 21(Suppl 2):21\u2013137. https:\/\/doi.org\/10.1111\/ajt.16502","journal-title":"Am J Transplant"},{"issue":"5","key":"1746_CR7","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1053\/j.ackd.2016.07.001","volume":"23","author":"JH Wang","year":"2016","unstructured":"Wang JH, Skeans MA, Israni AK (2016) Current status of kidney transplant outcomes: dying to survive. Adv Chronic Kidney Dis 23(5):281\u2013286. https:\/\/doi.org\/10.1053\/j.ackd.2016.07.001","journal-title":"Adv Chronic Kidney Dis"},{"issue":"19","key":"1746_CR8","doi-asserted-by":"publisher","first-page":"1967","DOI":"10.1056\/NEJMoa060068","volume":"355","author":"DC Brennan","year":"2006","unstructured":"Brennan DC, Daller JA, Lake KD, Cibrik D, Del Castillo D (2006) Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med 355(19):1967\u20131977. https:\/\/doi.org\/10.1056\/NEJMoa060068","journal-title":"N Engl J Med"},{"issue":"7","key":"1746_CR9","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1111\/j.1432-2277.2008.00642.x","volume":"21","author":"E Schadde","year":"2008","unstructured":"Schadde E, D\u2019Alessandro AM, Knechtle SJ, Odorico J, Becker Y, Pirsch J et al (2008) Alemtuzumab induction and triple maintenance immunotherapy in kidney transplantation from donors after cardiac death. Transpl Int 21(7):625\u2013636. https:\/\/doi.org\/10.1111\/j.1432-2277.2008.00642.x","journal-title":"Transpl Int"}],"container-title":["Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40620-023-01746-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40620-023-01746-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40620-023-01746-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T15:52:47Z","timestamp":1777564367000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/joneph\/article\/36\/7\/2133\/8304236"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,9]]},"references-count":9,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["1746"],"URL":"https:\/\/doi.org\/10.1007\/s40620-023-01746-1","relation":{},"ISSN":["1724-6059"],"issn-type":[{"value":"1724-6059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,9]]},"assertion":[{"value":"15 June 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the local Ethics Committee (796\/2020BO2) of T\u00fcbingen University hospital.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This study was conducted in accordance with the principles outlined in the Declaration of Helsinki. The study was approved by the local Ethics Committee (796\/2020BO2) of T\u00fcbingen University hospital. As a retrospective analysis, an informed consent to participate was not required. No animals were used in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and animal rights"}},{"value":"Not required.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent to participate"}},{"value":"Not applicable.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent for publication"}}]}}