Impact of Induction Therapy in Cardiac Transplant Patients in the Current Era

Abstract

Approximately half of all heart transplant programs utilize induction therapy during the early postoperative period. However, differences in survival using modern induction therapies have not been investigated in the current era. We selected all adult patients from the United Network for Organ Sharing (UNOS) database who underwent first time heart transplantation between 2008-2017 and received either induction therapy with anti-thymocyte globulin (ATG; n= 3747) or basiliximab (n=5157) or had no induction treatment (n=10,485). Kaplan Meier curves and multivariable Cox models compared the differences in survival among all three groups. Mean age of patients was 53.5 years and 25.7% were females. In general, patients who received ATG had longer wait times on the waitlist, had slightly higher ischemic times and there were fewer male recipients with female donors in this group. Upon follow up, 4,236 patients died. Kaplan Meier curves as displayed (Figure) suggested improved survival for those who received ATG compared to Basiliximab. In multivariable models, compared to patients who received ATG, those who received Basiliximab had higher risk of death (hazard ratio 1.11; p 0.02). There were no statistical differences in survival when patients who received ATG were compared to those who did not receive any induction therapy. In conclusion, induction therapy with ATG is associated with marginal survival benefit compared to induction therapy with basiliximab however there were no differences in long-term survival of patients who receive ATG when compared to those who did not receive any induction therapy.