The impact of induction therapy on mortality and treated rejection in cardiac transplantation: A retrospective study

Bellumkonda, Lavanya; Oikonomou, Evangelos; Hsueh, Christine; Maulion, Christopher; Testani, Jeffrey M.; Patel, J.

doi:10.1016/j.healun.2022.01.008

Cited by 8 publications

(14 citation statements)

References 32 publications

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“…Bellumkonda et al. recently found in their registry analysis that TCDA were associated with less treated rejection at 1 year, but IL2RA did not decrease the risk of treated rejection and was associated with an increased risk of mortality compared to no induction 4 …”

Section: Introductionmentioning

confidence: 93%

Basiliximab induction versus no induction in adult heart transplantation

Rudzik

Rivosecchi

Palmer

et al. 2023

Clinical Transplantation

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Background Induction immunosuppression in heart transplant recipients varies greatly by center. Basiliximab (BAS) is the most commonly used induction immunosuppressant but has not been shown to reduce rejection or improve survival. The objective of this retrospective study was to compare rejection, infection, and mortality within the first 12 months following heart transplant in patients who received BAS or no induction. Methods This was a retrospective cohort study of adult heart transplant recipients given BAS or no induction from January 1, 2017 to May 31, 2021. The primary endpoint was incidence of treated acute cellular rejection (ACR) at 12‐months post‐transplant. Secondary endpoints included ACR at 90 days post‐transplant, incidence of antibody‐mediated rejection (AMR) at 90 days and 1 year, incidence of infection, and all‐cause mortality at 1 year. Results A total of 108 patients received BAS, and 26 patients received no induction within the specified timeframe. There was a lower incidence of ACR within the first year in the BAS group compared to the no induction group (27.7 vs. 68.2%, p < .002). BAS was independently associated with a lower probability of having a rejection event during the first 12‐months post‐transplant (hazard ratio (HR) .285, 95% confidence interval [CI] .142–.571, p < .001). There was no difference in the rate of infection and in mortality after hospital discharge at 1‐year post‐transplant (6% vs. 0%, p = .20). Conclusion BAS appears to be associated with greater freedom from rejection without an increase in infections. BAS may be a preferred to a no induction strategy in patients undergoing heart transplantation.

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Section: Introductionmentioning

confidence: 93%

Basiliximab induction versus no induction in adult heart transplantation

Rudzik

Rivosecchi

Palmer

et al. 2023

Clinical Transplantation

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show abstract

“…The latest such study was a UNOS analysis of over 34,000 HT recipients published in 2022, which found that compared to no induction therapy, induction with depleting agents (i.e., thymoglobulin) was associated with reduction in risk of treated rejection at 1‐year with no effect on mortality, and IL2 receptor antagonist use was associated with a small but statistically significant increase in mortality without any impact on risk of rejection. This study, however, included patients transplanted from 2000 to 2017, and therefore does not address the central hypothesis that we sought to address in this study 4 …”

Section: Discussionmentioning

confidence: 99%

“…This study, however, included patients transplanted from 2000 to 2017, and therefore does not address the central hypothesis that we sought to address in this study. 4 The change in the allocation system has clearly altered the patient prototype for HT recipients. As compared to the prior era, patients awaiting transplant in the current era are more likely to be admitted to hospital, in the ICU, on ventilator support, and/or on temporary support with an IABP or ECMO, whereas patients in the pre-cohort are more likely to be ambulatory and on durable LVAD support.…”

Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

Impact of the United Network for Organ Sharing policy change on induction immunosuppression practice patterns and outcomes in adult heart transplant recipients

Jennings

Baker

2023

Pharmacotherapy

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Objective We evaluated whether the new allocation system altered induction practice patterns and affected outcomes in adult HT recipients. Design Retrospective, observational, cohort study. Data Source This study used data from the United Network for Organ Sharing (UNOS) database. Patients We included adults (18+ years of age) who had undergone HT and received induction immunosuppression and were stratified based on surgery being before (January 1, 2015–May 31, 2018) and after (May 1, 2018–December 31, 2021) the UNOS allocation policy change. Measurements Outcomes of 30‐day mortality, 1‐year mortality, and 1‐year graft failure were compared between those transplanted before and after the policy change through risk‐adjusted Cox proportional hazards models while drug‐treated rejection in the first year was compared using multiple logistic regression. Results Of the 7845 HT recipients who received induction therapy, 5070 (64.6%) were transplanted before and 2775 (35.4%) after the UNOS policy change. The most used induction agents were basiliximab (56.0%) and thymoglobulin (39.3%), with thymoglobulin used more often in the new (43.1%) than old system (37.2%; p < 0.001). Among adult HT recipients who received induction, risk‐adjusted hazards of 30‐day mortality (HR 0.89, 95% CI 0.67–1.18), 1‐year mortality (HR 1.00, 95% CI 0.84–1.19), and 1‐year graft failure (HR 0.83, 95% CI 0.60–1.15) were similar between the old and new systems. Conversely, the adjusted odds of drug‐treated rejection in the first year was lower in the new system (OR 0.52, 95% CI 0.38–0.72). Conclusions HT recipients in the new allocation system were more likely to receive thymoglobulin induction, which may be associated with a reduced risk of drug‐treated rejection.

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“…In contrast to the adult population, induction therapy has been increasingly used among pediatric heart transplant patients, approximately over 70% of pediatric patients in the United States receive induction treatment 5 . Compared to no induction therapy, induction with ATG was associated with reduction in risk of rejection during the first year after heart transplantation with no impact on overall graft survival and basiliximab was associated with increase in risk of mortality 6,7 . We have recently shown that CMV infection remains a significant risk factor in pediatric heart transplant recipients even with antiviral prophylaxis 8 .…”

Section: Introductionmentioning

confidence: 99%

“…5 Compared to no induction therapy, induction with ATG was associated with reduction in risk of rejection during the first year after heart transplantation with no impact on overall graft survival and basiliximab was associated with increase in risk of mortality. 6,7 We have recently shown that CMV infection remains a significant risk factor in pediatric heart transplant recipients even with antiviral prophylaxis. 8 However, the impact of ATG versus basiliximab on risk of CMV infection in pediatric heart transplant recipients with antiviral prophylaxis remains uncertain, particularly in patients with CMV-seropositive recipients (R + ) and in CMV-seronegative recipients receiving a seropositive heart (D + R − ).…”

mentioning

confidence: 99%

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

Zang

Zhang

Niu

et al. 2022

Clinical Transplantation

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Objectives Induction therapy has been increasingly used in pediatric heart transplantation. This study evaluated the impact of anti‐thymocyte globulin (ATG) versus basiliximab as induction therapy on post‐transplant cytomegalovirus (CMV) infection, rejection at 1 year, coronary allograft vasculopathy (CAV), and mortality in pediatric heart transplant recipients receiving antiviral prophylaxis. Results Of the 96 patients (age < 18 years) analyzed, 46 (47.9%) patients received basiliximab, and 50 (52.1%) received ATG. Median follow‐up was 3.0 (IQR, 1.7–4.9) years with 32.3% reporting CMV infection. The ATG group, as compared with the basiliximab group, had similar incidences of CMV infection (36% vs. 28.3%, p = .418), CMV viremia (22% vs. 19.6%, p = .769), and CMV‐positive tissue biopsy (30% vs. 22%, p = .486). The ATG group had lower incidences of rejection at 1 year (16% vs. 36.9%, p = .022) and CAV (4% vs. 23.9%, p = .006) with no difference in mortality (8% vs. 15.2%, p = .343), compared with the basiliximab group. Multivariate analysis showed that induction with ATG was associated with a lower risk of rejection at 1 year (OR, .31; 95% CI, .09–.94; p = .039) with no impact on the incidences of CMV infection (HR, 2.06; 95% CI, .54–7.89; p = .292), CAV (HR, .30; 95% CI, .04–2.58; p = .275), and mortality (HR, .39; 95% CI, .09–1.82; p = .233) compared to basiliximab induction. Discussion and conclusions In conclusion, induction with ATG was associated with reduction in risk of rejection at 1 year with no effects on CMV infection, CAV, and mortality in pediatric heart transplant recipients with universal antiviral prophylaxis compared with basiliximab induction therapy.

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The impact of induction therapy on mortality and treated rejection in cardiac transplantation: A retrospective study

Cited by 8 publications

References 32 publications

Basiliximab induction versus no induction in adult heart transplantation

Basiliximab induction versus no induction in adult heart transplantation

Impact of the United Network for Organ Sharing policy change on induction immunosuppression practice patterns and outcomes in adult heart transplant recipients

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

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