{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T14:02:34Z","timestamp":1792677754076,"version":"4.5.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2016,9]]},"abstract":"\n Background and objectives<\/jats:title>\n IL-2 receptor antagonist (IL2-RA) is recommended as a first-line agent for induction therapy in renal transplantation. However, this remains controversial in deceased donor renal transplantation (DDRT) maintained on tacrolimus (TAC)\/mycophenolic acid (MPA) with or without steroids.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n \n We studied the United Network for Organ Sharing Registry for patients receiving DDRT from 2000 to 2012 maintained on TAC\/MPA at transplantation hospital discharge (\n n<\/jats:italic>\n =74,627) to compare outcomes of IL2-RA and other induction agents. We initially divided the cohort into two groups on the basis of steroid use at the time of discharge: steroid (\n n<\/jats:italic>\n =59,010) versus no steroid (\n n<\/jats:italic>\n =15,617). Each group was stratified into induction categories: IL2-RA, rabbit antithymocyte globulin (r-ATG), alemtuzumab, and no induction. The main outcomes were incidence of acute rejection within the first year and overall graft failure (defined as graft failure and\/or death) post-transplantation. Propensity score (PS), specifically inverse probability of treatment weight, analysis was used to minimize selection bias caused by nonrandom assignment of induction therapies.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Median (25th, 75th percentiles) follow-up times were 3.9 (1.1, 5.9) and 3.2 (1.1, 4.9) years for steroid and no steroid groups, respectively. Acute rejection within the first year and overall graft failure within 5 years of transplantation were more common in the no induction category (13.3%;\n P<\/jats:italic>\n <0.001 and 28%;\n P<\/jats:italic>\n =0.01, respectively) in the steroid group and the IL2-RA category (11.1%;\n P<\/jats:italic>\n =0.16 and 27.4%;\n P<\/jats:italic>\n <0.001, respectively) in the no steroid group. Compared with IL2-RA, PS\u2013weighted and covariate\u2013adjusted multivariable logistic and Cox analyses showed that outcomes in the steroid group were similar among induction categories, except that acute rejection was significantly lower with r-ATG (odds ratio [OR], 0.68; 95% confidence interval [95% CI], 0.62 to 0.74). In the no steroid group, compared with IL2-RA, odds of acute rejection with r-ATG (OR, 0.80; 95% CI, 0.60 to 1.00) and alemtuzumab (OR, 0.68; 95% CI, 0.53 to 0.88) were lower, and r-ATG was associated with better graft survival (hazard ratio, 0.86; 95% CI, 0.75 to 0.99).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In DDRT, compared with IL2-RA induction, no induction was associated with similar outcomes when TAC\/MPA\/steroids were used. r-ATG seems to offer better graft survival over IL2-RA in steroid avoidance protocols.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.13171215","type":"journal-article","created":{"date-parts":[[2016,6,30]],"date-time":"2016-06-30T22:43:48Z","timestamp":1467326628000},"page":"1650-1661","source":"Crossref","is-referenced-by-count":60,"title":["Acute Rejection Rates and Graft Outcomes According to Induction Regimen among Recipients of Kidneys from Deceased Donors Treated with Tacrolimus and Mycophenolate"],"prefix":"10.2215","volume":"11","author":[{"given":"Bekir","family":"Tanriover","sequence":"first","affiliation":[{"name":"Division of Nephrology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal","family":"Jaikaransingh","sequence":"additional","affiliation":[{"name":"Division of Nephrology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm P.","family":"MacConmara","sequence":"additional","affiliation":[{"name":"Departments of Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin R.","family":"Parekh","sequence":"additional","affiliation":[{"name":"Departments of Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swee-Ling","family":"Levea","sequence":"additional","affiliation":[{"name":"Division of Nephrology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkatesh K.","family":"Ariyamuthu","sequence":"additional","affiliation":[{"name":"Division of Nephrology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song","family":"Zhang","sequence":"additional","affiliation":[{"name":"Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ang","family":"Gao","sequence":"additional","affiliation":[{"name":"Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet U.S.","family":"Ayvaci","sequence":"additional","affiliation":[{"name":"Information Systems, Naveen Jindal School of Management, University of Texas at Dallas, Dallas, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burhaneddin","family":"Sandikci","sequence":"additional","affiliation":[{"name":"Booth School of Business, University of Chicago, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilum","family":"Rajora","sequence":"additional","affiliation":[{"name":"Division of Nephrology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaqar","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Texas Tech University Health Sciences Center, Lubbock, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher Y.","family":"Lu","sequence":"additional","affiliation":[{"name":"Division of Nephrology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumit","family":"Mohan","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel A.","family":"Vazquez","sequence":"additional","affiliation":[{"name":"Division of Nephrology and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2016,6,30]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1111\/tri.12043","article-title":"Selection of induction therapy in kidney transplantation.","volume":"26","author":"Hardinger","year":"2013","journal-title":"Transpl Int"},{"issue":"Suppl 1","key":"B2-20230813","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/ajt.12579","article-title":"OPTN\/SRTR 2012 Annual Data Report: Kidney.","volume":"14","author":"Matas","year":"2014","journal-title":"Am J Transplant"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"923","DOI":"10.2215\/CJN.03800415","article-title":"Induction therapy in renal transplantation: Why? What agent? What dose? We may never know.","volume":"10","author":"Wiseman","year":"2015","journal-title":"Clin J Am Soc Nephrol"},{"key":"B4-20230813","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1053\/j.ajkd.2010.04.010","article-title":"KDOQI US commentary on the 2009 KDIGO clinical practice guideline for the care of kidney transplant recipients.","volume":"56","author":"Bia","year":"2010","journal-title":"Am J Kidney Dis"},{"issue":"Suppl 3","key":"B5-20230813","first-page":"S1","article-title":"KDIGO clinical practice guideline for the care of kidney transplant recipients.","volume":"9","year":"2009","journal-title":"Am J Transplant"},{"key":"B6-20230813","first-page":"CD003897","article-title":"Interleukin 2 receptor antagonists for kidney transplant recipients.","volume":"1","author":"Webster","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"key":"B7-20230813","first-page":"CD003897","article-title":"Interleukin 2 receptor antagonists for kidney transplant 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immunosuppression.","volume":"90","author":"Gralla","year":"2010","journal-title":"Transplantation"},{"key":"B11-20230813","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1097\/TP.0b013e3181a484d7","article-title":"Early outcomes of thymoglobulin and basiliximab induction in kidney transplantation: Application of statistical approaches to reduce bias in observational comparisons.","volume":"87","author":"Willoughby","year":"2009","journal-title":"Transplantation"},{"key":"B12-20230813","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1111\/ajt.12303","article-title":"Alefacept combined with tacrolimus, mycophenolate mofetil and steroids in de novo kidney transplantation: A randomized controlled trial.","volume":"13","author":"Rostaing","year":"2013","journal-title":"Am J Transplant"},{"key":"B13-20230813","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.2215\/CJN.08710814","article-title":"Induction therapies in live donor kidney transplantation on 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comparison of more than two treatment arms: An introduction from a case study in mental health.","volume":"48","author":"Spreeuwenberg","year":"2010","journal-title":"Med Care"},{"key":"B17-20230813","doi-asserted-by":"crossref","first-page":"249","DOI":"10.2307\/2533160","article-title":"Matching using estimated propensity scores: Relating theory to practice.","volume":"52","author":"Rubin","year":"1996","journal-title":"Biometrics"},{"key":"B18-20230813","doi-asserted-by":"crossref","first-page":"2265","DOI":"10.1002\/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO;2-B","article-title":"Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group.","volume":"17","author":"D\u2019Agostino","year":"1998","journal-title":"Stat Med"},{"key":"B19-20230813","doi-asserted-by":"crossref","first-page":"2562","DOI":"10.1056\/NEJMoa067411","article-title":"Reduced exposure to calcineurin inhibitors in renal 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prospective randomized study.","volume":"68","author":"Ahsan","year":"1999","journal-title":"Transplantation"},{"key":"B23-20230813","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1097\/00007890-200011150-00015","article-title":"Double-blind comparison of two corticosteroid regimens plus mycophenolate mofetil and cyclosporine for prevention of acute renal allograft rejection.","volume":"70","author":"Vanrenterghem","year":"2000","journal-title":"Transplantation"},{"key":"B24-20230813","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1681\/ASN.V11101910","article-title":"A meta-analysis of immunosuppression withdrawal trials in renal transplantation.","volume":"11","author":"Kasiske","year":"2000","journal-title":"J Am Soc Nephrol"},{"key":"B25-20230813","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/j.1600-6143.2007.02057.x","article-title":"A randomized, multicenter study of steroid avoidance, early steroid withdrawal or standard steroid therapy in kidney transplant recipients.","volume":"8","author":"Vincenti","year":"2008","journal-title":"Am J Transplant"},{"key":"B26-20230813","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/j.1600-6143.2004.00655.x","article-title":"A multicenter pilot study of early (4-day) steroid cessation in renal transplant recipients under simulect, tacrolimus and sirolimus.","volume":"5","author":"Woodle","year":"2005","journal-title":"Am J Transplant"},{"key":"B27-20230813","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1016\/j.transproceed.2006.02.116","article-title":"Acute rejection risk in kidney transplant recipients on steroid-avoidance immunosuppression receiving induction with either antithymocyte globulin or basiliximab.","volume":"38","author":"Heilman","year":"2006","journal-title":"Transplant Proc"},{"key":"B28-20230813","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1097\/01.TP.0000441089.39840.66","article-title":"Randomized trial of three induction antibodies in kidney transplantation: Long-term results.","volume":"97","author":"Ciancio","year":"2014","journal-title":"Transplantation"},{"key":"B29-20230813","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1097\/SLA.0b013e318187d1da","article-title":"A prospective, randomized, double-blind, placebo-controlled multicenter trial comparing early (7 day) corticosteroid cessation versus long-term, low-dose corticosteroid therapy.","volume":"248","author":"Woodle","year":"2008","journal-title":"Ann Surg"},{"key":"B30-20230813","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1056\/NEJMoa1009546","article-title":"Alemtuzumab induction in renal transplantation.","volume":"364","author":"Hanaway","year":"2011","journal-title":"N Engl J Med"},{"key":"B31-20230813","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1093\/ndt\/gfr374","article-title":"Very early steroid withdrawal or complete avoidance for kidney transplant recipients: A systematic 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study.","volume":"3","author":"Knechtle","year":"2003","journal-title":"Am J Transplant"},{"key":"B35-20230813","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1086\/510388","article-title":"Opportunistic infections in 547 organ transplant recipients receiving alemtuzumab, a humanized monoclonal CD-52 antibody.","volume":"44","author":"Peleg","year":"2007","journal-title":"Clin Infect Dis"},{"key":"B36-20230813","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1097\/TP.0000000000000449","article-title":"Association of antibody induction immunosuppression with cancer after kidney transplantation.","volume":"99","author":"Hall","year":"2015","journal-title":"Transplantation"},{"key":"B37-20230813","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1056\/NEJMoa060068","article-title":"Rabbit antithymocyte globulin versus basiliximab in renal transplantation.","volume":"355","author":"Brennan","year":"2006","journal-title":"N Engl J 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update.","volume":"32","author":"Hertig","year":"2015","journal-title":"Transpl Immunol"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201609000-00018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:46:38Z","timestamp":1786369598000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201609000-00018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,6,30]]},"references-count":40,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2016]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.13171215","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,6,30]]}}}