Impact of induction strategy change on first‐year rejection in pediatric heart transplantation at a single center—From postoperative basiliximab to either postoperative anti‐thymocyte globulin or preoperative basiliximab

Abstract

Background Our pediatric heart transplant center transitioned from post‐bypass basiliximab (BAS) induction to either anti‐thymocyte globulin (ATG) or pre‐bypass BAS. The purpose of this study was to compare first‐year rejection rates before and after this change. Methods A single‐center retrospective analysis was conducted of pediatric heart transplant recipients from 2010 to 2019. Primary outcome was first‐year rejection. Bivariate analysis, Kaplan‐Meier curves, and multivariable regression were performed across eras. Results Forty‐three early era patients (55%) received post‐bypass BAS, and 35 late era patients (45%) received pre‐bypass BAS (n = 17) or ATG (n = 18). First‐year rejection decreased in the late era (31% vs 53%, p = .05). This finding was more pronounced after excluding infants (38% vs 73%, p = .006). Late era was associated with a decreased likelihood of rejection (all cohort OR 0.19, 95% CI 0.05‐0.66; infants excluded OR 0.17, 95% CI 0.04‐0.61). No differences in post‐transplant lymphoproliferative disease, donor‐specific antibody, or infection were observed. Conclusions Fewer late era patients receiving ATG or pre‐bypass BAS induction had first‐year rejection compared to the early era patients receiving standard post‐bypass BAS induction. This programmatic shift in induction strategy was readily achievable and potentially effective in reducing first‐year rejection.

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

“…In our study, 12‐month rejection rates were lower among patients receiving ATG than those receiving basiliximab, which was further confirmed by multivariable‐adjusted logistic regression analysis. The results obtained from our study are consistent with the previous reports 6,22,23 …”

“…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.…”

“…An analysis of the International Society for Heart and Lung Transplantation (ISHLT) database for pediatric heart transplants from January 1, 2000, to June 30, 2015, reported lower 1-year rejection rates among the ATG group versus the basiliximab group, with improved late graft survival. 22 A recent observational study performed by Sisson et al 23 reported that pediatric heart transplant recipients receiving ATG had decreased rates of first-year rejection compared with the patients receiving standard induction therapy with basiliximab. In our study, 12-month rejection rates were lower among patients receiving ATG than those receiving basiliximab, which was further confirmed by multivariable-adjusted logistic regression analysis.…”