Induction Therapy after Heart Transplantation

Abstract

The use of induction therapy for orthotopic heart transplant (OHT) recipients is inconsistent between centers and there are limited data that explore the association with post-transplant outcomes. We used the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Transplant Registry to investigate induction therapy use after OHT and its relationship to 1-year survival. This is a retrospective cohort study from the global ISHLT Registry of adult patients who received a first OHT between 1/2005 and 6/2017. We excluded multi-organ transplant recipients, and those with missing induction data or no post-transplant follow up. We describe recipient and donor characteristics, stratified by induction therapy use. We used Kaplan-Meier methods to estimate 1-year mortality for induction therapy use and non-use, with comparison by the log-rank test. Of 27,400 OHT recipients included in this analysis, 13,711 (50%) received induction therapy at the time of transplant. The use of induction therapy remained stable over the study period. Both groups had median age of 55 years and had nonischemic cardiomyopathy as the most frequent diagnosis. There was a higher rate of females in the induction group (25.5% vs 24.2%). Recipients who received induction therapy had higher rates of pre-transplant dialysis (2.5% vs 2.1%) and ventilator use (2.6% vs 1.1%) but not ventricular assist device use (35.5% vs 39.9%). Atgam/thymoglobulin and basiliximab were the most frequently used therapies (N=5139 [37.5%] and N=7691 [56.1%], respectively). There was no significant difference in 1-year unadjusted survival between those who received induction therapy and those who did not. (Figure) CONCLUSION: In a large international cohort, approximately half of OHT recipients received induction therapy after heart transplantation, with similar one-year survival compared to those who did not receive induction therapy. Further study is warranted to determine which recipients warrant consideration for induction therapy and the optimal agent.