Efficacy and Safety of Induction Therapy in Kidney Transplant Recipients: A Propensity Score Matching Analysis in a Multicenter Retrospective Observational Study

Bacground: This study aimed to compare the efficacy and safety of induction treatments in kidney transplant recipients. Methods: A total of 2564 kidney transplant recipients from 15 transplant centers were included in the study and were categorized into 3 groups for comparison. Group 1: No induction (n = 222, 8.7%), Group 2: Anti-T lymphocyte globulin (ATLG, n = 1794, 70%) and Group 3: Basiliximab (n = 548, 21.4%). The results were compared across 3 post-transplant periods: the first month, the 1st to 6th month, and the 6th to 12th month. Results: Prior to propensity score matching (PSM), there were no significant differences in graft/patient survival, BKV (polyomavirus) incidence, or rejection rates during the first month among the groups. However, the Anti-T lymphocyte globulin (ATLG) group exhibited higher rates of developing donor-specific antibodies (DSA), cytomegalovirus (CMV) infection, general infections, and delayed graft function (DGF), along with higher rejection rates at 1 month post-transplant. After the PSM analysis, rejection rates (which were higher in the ATLG group compared to the Basiliximab group only in the first month), graft/patient loss, and BKV rates were comparable. Infection, CMV, and DSA rates remained elevated in the ATLG group. Clinical results of groups 1 and 3 were similar. Conclusions: This study shown that ATLG provides positive clinical results despite increased infection and DSA formation in patients with high immunological risk, whereas the efficacy and necessity of induction in patients with low-moderate immunological risk is debatable.