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To induce or not to induce: a 21st century evaluation of lung transplant immunosuppression's effect on survival
Author(s) -
Whitson Bryan A.,
Lehman Amy,
Wehr Allison,
Hayes Don,
Kirkby Stephen,
PopeHarman Amy,
Kilic Ahmet,
Higgins Robert S.D.
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12339
Subject(s) - medicine , immunosuppression , immunology , lung transplantation , lung , intensive care medicine
The impact of induction immunosuppression on long‐term survival in lung transplant recipients remains unclear. We sought to evaluate the effect of contemporary induction immunosuppression agents in lung transplant recipients’ survival, utilizing national registry data. Methods We queried the United Network for Organ Sharing registry from 2001 to 2012 for adult, deceased donor lung transplants who received no antibody‐based induction ( NONE ) or the contemporary agents of basiliximab, alemtuzumab, thymoglobulin, antilymphocyte globulin, or antithymocyte globulin ( INDUCED ). Kaplan– M eier estimates of the survival and C ox proportional hazards models assessed differences in overall survival between the INDUCED and NONE groups; logistic regression models assessed differences in survival and rejection ( TR 1 Y ). Results There were 23 951 lung transplants performed with 12 858 meeting the inclusion criteria; 5713 (44%) were INDUCED . Of INDUCED agents, 62% were basiliximab and 14% alemtuzumab. Being INDUCED significantly increased overall survival (p < 0.0001). Median INDUCED survival was 71.3 months (confidence interval [ CI ]: 65.7–75.5) as compared with 63.2 months ( CI : 60.1–65.9). Of INDUCED , both basiliximab and alemtuzumab had higher median survival times at 75.1 months ( CI : 68.6–81.3) and 75.5 months ( CI : 63.5–∞), respectively. There was less TR 1Y in INDUCED patients (37%), as compared to NONE (42%; p < 0.0001). Conclusion In a contemporary analysis of lung transplant recipients, induction immunosuppression has a significantly positive effect on survival.