Impact of induction therapy on cytomegalovirus infection and post-transplant outcomes in pediatric heart transplant recipients receiving routine antiviral prophylaxis.

Abstract

Induction therapy has been increasingly used in pediatric heart transplantation. This study evaluated the impact of anti-thymocyte globulin (ATG) versus basiliximab as induction therapy on post-transplant cytomegalovirus (CMV) infection, rejection at 1 year, coronary allograft vasculopathy (CAV), and mortality in pediatric heart transplant recipients receiving antiviral prophylaxis. Of the 96 patients (age<18 years) analyzed, 46 (47.9%) patients received basiliximab, and 50 (52.1%) received ATG. Median follow-up was 3.0 (IQR, 1.7-4.9) years with 32.3% reporting CMV infection. The ATG group, as compared with the basiliximab group, had similar incidences of CMV infection (36%vs. 28.3%, p=.418), CMV viremia (22%vs. 19.6%, p=.769), and CMV-positive tissue biopsy (30%vs. 22%, p=.486). The ATG group had lower incidences of rejection at 1 year (16%vs. 36.9%, p=.022) and CAV (4%vs. 23.9%, p=.006) with no difference in mortality (8% vs. 15.2%, p=.343), compared with the basiliximab group. Multivariate analysis showed that induction with ATG was associated with a lower risk of rejection at 1 year (OR, .31; 95% CI, .09-.94; p=.039) with no impact on the incidences of CMV infection (HR, 2.06; 95% CI, .54-7.89; p=.292), CAV (HR, .30; 95% CI, .04-2.58; p=.275), and mortality (HR, .39; 95% CI, .09-1.82; p=.233) compared to basiliximab induction. In conclusion, induction with ATG was associated with reduction in risk of rejection at 1 year with no effects on CMV infection, CAV, and mortality in pediatric heart transplant recipients with universal antiviral prophylaxis compared with basiliximab induction therapy.