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Induction immunosuppression strategies and long‐term outcomes after heart transplantation
Author(s) -
Nozohoor Shahab,
Stehlik Josef,
Lund Lars H.,
Ansari David,
Andersson Bodil,
Nilsson Johan
Publication year - 2020
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.13871
Subject(s) - medicine , basiliximab , heart transplantation , transplantation , immunosuppression , lung transplantation , panel reactive antibody , cumulative incidence , hazard ratio , proportional hazards model , malignancy , surgery , confidence interval , kidney transplantation
Although the use of induction therapy has reduced the risk of acute rejection after heart transplantation, its use may be associated with other adverse outcomes. We aimed to examine the effect of no induction (NoInd), induction with basiliximab (BAS), or induction with antithymocyte globulin (ATG) on outcome after heart transplantation. We analyzed data from the International Society for Heart and Lung Transplantation (ISHLT) registry for adult heart transplants performed between 2000 and 2013. The primary outcome was cumulative all‐cause mortality, and the secondary outcome was cause‐specific death. We identified 27 369 transplants whose recipients received NoInd (n = 15 688), ATG (n = 6830), or BAS (n = 4851). Over a median follow‐up of 1497 days, overall 30‐day mortality was 5% and 1‐year mortality was 11%. Survival after transplant was similar in patients treated with NoInd compared with ATG. The survival was improved using NoInd compared with BAS (log‐rank P = .040), adjustment HR = 1.11 (95% CI, 1.04‐1.19). Compared to NoInd, BAS was associated with higher risk of graft failure‐related deaths, HR = 1.27 (95% CI, 1.02‐1.58), and ATG was associated with higher risk of malignancy‐related deaths, HR = 1.18 (95% CI, 1.01‐1.39). Survival of patients who received NoInd was similar to ATG and better compared with BAS. Further, the use of ATG may be associated with increased malignancy‐related mortality, compared with NoInd.