Induction immunosuppression agents as risk factors for incident cardiovascular events and mortality after kidney transplantation

Shaifali Sandal, Sunjae Bae, Mara McAdams-DeMarco, Allan B. Massie, Krista L. Lentine, Marcelo Cantarovich, Dorry L. Segev

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Low T cell counts and acute rejection are associated with increased cardiovascular events (CVEs); T cell–depleting agents decrease both. Thus, we aimed to characterize the risk of CVEs by using an induction agent used in kidney transplant recipients. We conducted a secondary data analysis of patients who received a kidney transplant and used Medicare as their primary insurance from 1999 to 2010. Outcomes of interest were incident CVE, all-cause mortality, CVE-related mortality, and a composite outcome of mortality and CVE. Of 47 258 recipients, 29.3% received IL-2 receptor antagonist (IL-2RA), 33.3% received anti-thymocyte globulin (ATG), 7.3% received alemtuzumab, and 30.0% received no induction. Compared with IL-2RA, there was no difference in the risk of CVE in the ATG (adjusted hazard ratio [aHR] 0.98, 95% confidence interval [CI] 0.92-1.05) and alemtuzumab group (aHR 1.01, 95% CI 0.89-1.16), but slightly higher in the no induction group (aHR 1.06, 95% CI 1.00-1.14). Acute rejection did not modify this association in the latter group but did increase CVE by 46% in the alemtuzumab group. There was no difference in the hazard of all-cause or CVE-related mortality. Only in the ATG group, a 7% lower hazard of the composite outcome of mortality and CVE was noted. Induction agents are not associated with incident CVE, although prospective trials are needed to determine a personalized approach to prevention.

Original languageEnglish (US)
Pages (from-to)1150-1159
Number of pages10
JournalAmerican Journal of Transplantation
Issue number4
StatePublished - Apr 2019


  • alemtuzumab
  • basiliximab/daclizumab
  • cardiovascular disease
  • clinical research/practice
  • coronary artery disease
  • graft survival
  • health services and outcomes research
  • immunosuppressant - fusion proteins and monoclonal antibodies
  • immunosuppression/immune modulation
  • kidney transplantation/nephrology

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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