Abstract 18653: Outcomes After Induction Immunosuppression in Heart Transplant Patients
Introduction: Outcomes after induction immunosuppression in heart transplant patients have not been investigated since the heart allocation policy was changed in 2006. The optimal induction therapy continues to be controversial with many centers continuing to use none at all. We evaluated the outcomes after modern induction immunosuppression agents with the primary end points being survival and rejection.
Methods: The United Network for Organ Sharing (UNOS) database was examined for all heart transplants from January 2006 to December 2012. Patients receiving induction therapy were compared to those receiving no induction agent. Additional subgroup analysis was performed on the induction group including those patients receiving either basiliximab (Simulect), thymoglobulin, or alemtuzumab (Campath). Kaplan Meier survival curves and multivariate cox regression analysis were utilized to evaluate outcomes.
Results: Of the 14,210 heart transplants performed during this time period, 5905 (41%) received no induction while 8605 (59%) received induction therapy. Interestingly, the no induction group had a lower incidence of acute rejection (15.5% vs. 36.8%, p = 0.005). However, Kaplan Meier analysis revealed no difference in survival between the two cohorts (6.36 vs. 6.23 years; p = 0.59). On multivariate analysis, induction was not associated with a survival advantage (HR: 0.95; 0.88 - 1.03, p = 0.23). Subgroup analysis revealed that patients receiving Campath had the highest incidence of acute rejection (29.5% vs. 19.3% vs. 9.6%, p < 0.0001) and highest panel reactive antibody (7.6 vs 4.3 vs. 4.9, p = 0.002) while those receiving thymoglobulin had the lowest. However, Simulect (HR: 1.08; 0.97 - 1.19, p = 0.16), Campath (HR: 0.87; 0.69 - 1.09, p = 0.22), and Thymoglobulin (HR: 0.94; 0.77 - 1.14, p = 0.50) did not provide a survival benefit on multivariate or Kaplan Meier analysis (6.26 vs. 5.59 vs. 6.26 years; p = 0.21).
Conclusions: This analysis of induction agents on outcomes after heart transplantation since the change in allocation policy in 2006 shows that induction does not affect survival when compared to no induction. Furthermore, there is no difference in survival when comparing the three most commonly used agents: Simulect, Campath, and thymoglobulin.
Author Disclosures: V. Ambur: None. S. Taghavi: None. Y. Furuya: None. S. Jayarajan: None. A. Shiose: None. E. Leotta: None. J. Gomez-Abraham: None. Y. Toyoda: None.
- © 2015 by American Heart Association, Inc.