Induction therapy: Clinical and quality of life outcomes in aged renal transplant recipients

Background: One primary purpose of transplant is to improve quality of life (QOL) in renal transplant recipients (RTRs) ≥50 yr of age, where death with a functioning graft limits life years gained. We aimed to determine the impact of induction therapy, with its subsequent effects on rejection, infection, and readmissions, on QOL. Methods: Subanalysis of patients ≥50 yr of age that participated in a single-center, prospective, risk-stratified, randomized, open-label study. Two hundred RTRs ≥ 50 yr of age. Interventions: All patients received either rabbit antithymocyte globulin (rATG) or interleukin 2 receptor antagonists (IL-2RA) in addition to tacrolimus (FK), mycophenolate mofetil (MMF), and corticosteroids in a randomized fashion. Outcome analyses included safety, efficacy, and QOL. Results: Results reported 1 yr post-transplant. Of 111 patients ≥50 yr old, 48 received IL-2RA and 63 received rATG. Baseline characteristics were similar between groups. Patients that received rATG had a trend toward lower acute rejection rates, fewer readmissions, and fewer supratherapeutic tacrolimus troughs, with similar rates of infections. QOL analysis demonstrated patients that received rATG were significantly more likely to have improvements in physical and social functioning after transplant. Conclusions: Contrary to the common practice, T-cell depletion in recipients ≥50 yr of age may be beneficial.