(903) - Effect of Induction Therapy on Graft Survival in Primary Pediatric Heart Transplantation: A Propensity Score Analysis of the UNOS Database

Abstract

Induction therapy use in pediatric heart transplantation has increased. The aim of this study is to investigate the effect of induction therapy on graft survival. The UNOS database was queried for isolated pediatric heart transplants (age < 18 years) from January 1, 1994 to December 31, 2013. Propensity scores for induction treatment were calculated by estimating probability of induction using a logistic regression model. Transplants were matched between induction treatment groups based upon the propensity score, reducing potential biases. Using only propensity score matched transplants, the effect of induction therapy on graft survival was investigated using Cox-proportional hazards. Of 3741 pediatric heart transplants with complete data for use in the propensity score, 2792 transplants were successfully propensity score matched (induction n=1396, no induction n=1396). There were no significant differences in transplant and pre-transplant covariates between induction groups (Table 1). Graft survival in the induction group at 1, 5 and 10 years post-transplant was 91%, 76%, and 61%, respectively, versus 88%, 72%, and 56% graft survival in the no induction cohort. In the Cox-proportional hazards model, the use of induction of was not associated with graft loss (HR 1.14 95%CI 0.98-1.33, p-value =0.09). Induction therapy is not associated with improved graft survival in primary pediatric heart transplantation. Further studies should investigate if different subgroups of pediatric heart transplant recipients benefit from induction therapy.