Additional coauthors declare no conflict of interest. Supplementary Material Supplemental Data: Click here to view. Acknowledgments On the basis of the Organ Procurement and Transplantation Network data as of September 30, 2013, this work was supported, in part, by Health Resources and Services Administration contract 234-2005-370011C. Cox regression models were used to estimate the risk ratios (HRs) associated with overall and deathCcensored allograft failure risk. ideals 0.05 were considered statistically significant. Statistical analyses were performed with SAS software (version 9.3; SAS Institute Inc., Cary, NC) and Stata MP14 software (StataCorp., College Train station, TX). Multivariable logistic and Cox models were modified for donor factors (sex and kidney donor profile index [KDPI] [14]), recipient factors (age, sex, race, diabetes status, cardiovascular disease, maximum panel reactive antibodies [PRAs], retransplant status, and dialysis exposure), transplant factors (chilly ischemia time [CIT], donor-to-recipient excess weight percentage, HLA mismatch, and transplant yr), transplant center (to account for center effect on induction strategy), and the OPTN region (to account for geographic variations). Approximately 40% of maximum PRA data were missing across both organizations and all groups. Because PRA is definitely a strong predictor of rejection and graft failure, and strongly associated with induction strategy, we included the recipients with missing PRA data as a separate category (in addition to 0%C20%, 20%C80%, and 80%C100% groups) in the multivariable logistic and Cox models. PRA has been reported to the UNOS/OPTN more regularly and accurately since 2007. PS Analyses. The PS was derived from multinomial logistic regression using the same covariates MC-Val-Cit-PAB-carfilzomib as with the adjusted analysis to control for potential selection bias caused by nonrandom task of induction treatments. We specifically used the inverse probability of treatment excess weight, in which the weights were determined as the inverse of the PS (13,15C18). Details regarding calculation of PS can be found in Supplemental Material MC-Val-Cit-PAB-carfilzomib and our previous publication. Subgroup Analyses. A subgroup analysis was performed for high-risk recipients (including CIT 24 hours, retransplantation, black race, KDPI 85%, and PRA 0%) and low-risk recipients (not having any of above risks factors) regarding main results in both steroid organizations. Results Characteristics of the Study Cohort The changing tendency for use of induction therapy in recipients of DDRTs in the United States is definitely illustrated in Number 1. The use of lymphocyte-depleting antibody (r-ATG and alemtuzumab) has been gradually increased over the past decade. Recipient, donor, and transplant characteristics for both steroid organizations and their induction groups are summarized in Furniture 1 and ?and2.2. Around 15% of the recipients received preemptive transplants across all groups. Before the PS adjustment, most ideals were clinically significant. However, after the PS, all ideals, with the exceptions of dialysis exposure, CIT, and transplant yr in the steroid group and recipient age in the no steroid group, were no longer statistically significant. Table 1. Characteristics of donor, recipient, and transplant factors in the steroid group Valuevalues are not reported, because those variables are not included in the propensity score analysis. Table 2. Characteristics of donor, recipient, and transplant factors in the no steroid group Valuevalues are not reported, because those variables are not included in the propensity score analysis. Results Median (25th, 75th percentiles) follow-up instances were 3.9 (1.1, 5.9) and 3.2 (1.1, 4.9) years for the steroid and no steroid groups, respectively. Number 2 illustrates the tendency in incidence of acute rejection within the 1st yr (percentage) among DDRT recipients. There has been a steady decrease in observed rejection rates among all induction groups (10% in 2012) over the past decade. However, RGS9 unadjusted overall allograft survivals at MC-Val-Cit-PAB-carfilzomib 3 years have stayed stable across all induction groups (approximately 85%) during the study period (Supplemental Number 1). The primary outcomes were observed more in the no induction category in the steroid group and the IL2-RA category in the no steroid group (Furniture 3 and ?and4).4). Unweighted KaplanCMeier curves for overall graft survival are demonstrated in Number 3. The overall graft survival curves were significantly different in both steroid organizations. Regarding secondary results, causes of death and allograft failure are summarized in Supplemental Furniture 1 and 2. Incidence of postCtransplant lymphoproliferative disorder for each.