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Induction immunosuppression for combined heart–lung transplantation
Author(s) -
Hayes Don,
McConnell Patrick I.,
Yates Andrew R.,
Tobias Joseph D.,
Galantowicz Mark,
Mansour Heidi M.,
Tumin Dmitry
Publication year - 2016
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.12827
Subject(s) - medicine , immunosuppression , basiliximab , thymoglobulin , alemtuzumab , anti thymocyte globulin , hazard ratio , univariate analysis , transplantation , multivariate analysis , proportional hazards model , heart transplantation , lung transplantation , surgery , kidney transplantation , confidence interval
Background Research on induction immunosuppression in patients undergoing combined heart–lung transplantation ( HLT x) is limited. Methods The United Network for Organ Sharing database was queried from 2000 to 2013 to examine the influence of induction immunosuppression for combined HLT x in adult (≥18 years) and adolescent (≥12 and <18 years) recipients. Results Of 394 eligible combined HLT x cases (361 adults, 33 adolescents), 384 were included in univariate Cox analysis and 116 in the multivariate Cox model. Univariate analysis demonstrated no differences in survival by induction medication and no difference among the most common maintenance immunosuppression regimens. Adjusting for use of corticosteroids, multivariate analysis demonstrated no benefit of basiliximab ( HR =3.582; 95% CI: 0.966, 13.279; P =.056), thymoglobulin/antilymphocyte globulin ( ALG )/antithymocyte globulin ( ATG ) (HR=0.808; 95% CI: 0.134, 4.888; P =.817), alemtuzumab ( HR =0.369; 95% CI: 0.087, 1.563; P =.176), or other induction medications ( HR =1.511; 95% CI: 0.146, 15.610; P =.729), compared to no induction medication, with respect to mortality hazard post‐ HLT x. There were also no differences in treated acute rejection episodes by type of induction immunosuppression. Conclusions Induction immunosuppression with contemporary agents does not improve survival after combined HLT x.