Moving towards an Induction-Free Era: Short-Term Renal and Infectious Outcomes

Abstract

Currently, 50% of heart transplant (HTx) programs worldwide use an induction therapy strategy despite limited evidence. Recently, our program moved from universal induction to a limited-induction strategy (only for high-risk individuals). The purpose of this analysis was to compare incidence of early infection and renal function in HTx recipients stratified by use induction therapy. Retrospective study in HTx recipients between 01/2012 and 05/2019 at a single institution. Post-transplant outcomes included survival, risk of infection, serum creatine trends and need for dialysis in HTx recipients by induction status. The KM method was used for survival and competing risk models for infection and dialysis. Between-group differences in survival and cumulative incidence rate were evaluated using log-rank and Gray's tests, respectively. Overall, 260 HTx recipients were included. Of those, 239 (91%) received induction while 21 (8%) did not. Patients were more likely male (70.8%) and Caucasian (55.8%). Overall 1-year survival [95%CI] was 89.7% [85.2%,92.8%]. The cumulative proportion of infection was significantly higher in the induction group (55.6% [48.7%, 61.5%] vs. no-Induction 39.2% [10.2%, 58.9%]) (Figure 1A). Need for dialysis was not significantly different between groups (Induction 6.8% [3.5%, 9.9%] vs. no induction 5.0% [0.0%, 14.1%] at 1 year (Figure 1B). Serum creatinine (mg/dL) trends are shown in Figure 1C. Baseline creatinine (IQR) was significantly higher the induction group (1.4 (1.1-1.8) vs. 1.14 (0.90-1.40), p=0.035) and on day 1 (1.6 (1.2-2.0) vs. 1.26 (0.90-1.60), p=0.22) but there were no significant differences thereafter. In our early experience with a selective induction strategy, we found a reduction in infection rates and no significant worsening in short term renal function in those who were not induced. This strategy appears safe yet warrants ongoing surveillance for long term patient outcomes.