Comparison of 10‐year graft failure rates after induction with basiliximab or anti‐thymocyte globulin in pediatric heart transplant recipients—The influence of race

Abstract

Background/Objective The impact of induction therapy in pediatric heart transplantation has been uncertain. Given the risk of poor outcomes in black pediatric heart transplant recipients, we evaluated the effect on graft survival of ATG and BAS induction in black and non‐black pediatric recipients. Methods This was a retrospective analysis of pediatric candidates (aged ≤18 years) who underwent heart transplantation from 2000 to 2016 identified from the UNOS database. Primary outcome was 10‐year graft survival. Results This study included 654 patients receiving BAS, 2385 patients receiving ATG, and 2425 receiving no induction. Ten‐year survival was similar for the following groups: non‐black BAS (57%), non‐black ATG (66%), and black ATG (51%). The black BAS group had a 10‐year graft survival of 39% which was inferior on pairwise comparison to the other groups (all P values < 0.001). On multivariate analysis, ATG was associated with decreased risk of graft failure when compared to no induction (HR 0.86, 95% CI 0.76‐0.97, P = 0.011) and had an association approaching statistical significance when compared to BAS induction (0.84, 0.7‐1.01, P = 0.069). This association was seen in black recipients in whom ATG was strongly associated with decreased risk of graft failure when compared to either no induction (0.65, 0.5‐0.83, P = 0.001) or BAS (0.64, 0.46‐0.89, P = 0.008) but was not seen in non‐black recipients. Conclusions Black pediatric heart transplant recipients who received ATG induction had an improved long‐term graft survival compared to those who received BAS induction or no induction.

Post-transplant mortality and graft failure after induction immunosuppression among Black heart transplant recipients in the United States

“…On the other hand, some studies have reported benefits of induction immunosuppression treatment in specific subgroups of patients 15,25,26 . A study of Black pediatric patients 26 reported that anti‐thymocyte globulin was associated with a lower 10‐year graft failure rate compared to no induction (HR = 0.65, 95% CI 0.5–0.83).…”

“…On the other hand, some studies have reported benefits of induction immunosuppression treatment in specific subgroups of patients 15,25,26 . A study of Black pediatric patients 26 reported that anti‐thymocyte globulin was associated with a lower 10‐year graft failure rate compared to no induction (HR = 0.65, 95% CI 0.5–0.83). Anti‐thymocyte globulin use has also been associated with a survival benefit for younger patients aged 21–39 but a trend toward worsened survival for older patients >60 years 25 .…”

Impact of induction therapy on cytomegalovirus infection and post‐transplant outcomes in pediatric heart transplant recipients receiving routine antiviral prophylaxis

“…The results obtained from our study are consistent with the previous reports. 6,22,23 Contrary to the findings of earlier studies that the use of ATG was associated with a decreased risk of mortality compared with those receiving basiliximab, 24,25 we observed no appreciable difference in the overall post-transplant mortality between the two induction agents by multivariable-adjusted Cox regression analysis, which is in line with the previous report. 6 Our study also did not find statistically significant differences in the incidence of CAV between the basiliximab and the ATG cohorts, despite previous reports claiming that the use of ATG was associated with a significant reduction in the incidence and severity of CAV compared to patients receiving basiliximab, 26 and patients with no induction therapy.…”

Heart Transplantation as a Treatment Method for Refractory Heart Failure due to Post-myocarditis Dilated Cardiomyopathy: a Clinical Case

“…У младенцев после трансплантации сердца васкулопатии развиваются редко, вероятно, вследствие возрастных особенностей иммунной системы [30]. Предполагалось, что так называемая индукционная иммуносупрессивная терапия, особенно с использованием антилимфоцитарного глобулина или базиликсимаба, снижает риск развития васкулопатии, хотя в недавно опубликованных обзорах этого не продемонстрировано, возможно, вследствие влияния дополнительных факторов [31,32].…”