Non-Depleting Induction Immunosuppression Is Associated with Less Clinically Significant Acute Cellular Rejection in Pediatric Heart Transplantation Recipients

Abstract

Purpose Induction immunosuppression is purported to decrease the risk of acute cellular rejection (ACR) early post-transplant. Thus, we performed a retrospective, sequential cohort study to compare the impact of no induction to non-depleting induction immunosuppression (daclizumab or basiliximab) on rejection, infections, and survival in pediatric heart transplant recipients (HTR). Methods and Materials HTRs less than 18 years of age at time of transplant who received no induction (n=24), daclizumab (n=27), or basiliximab (n=12) were identified. Cohorts were sequential in time (table). Time to rejection and survival were estimated using Cox proportional hazards regression. Results Baseline characteristics were similar between the groups with notable exceptions (table). Importantly, the no-induction cohort predominantly received cyclosporine-based (92%) immunosuppression; while the induction cohort received tacrolimus-based (97%) immunosuppression (p Conclusions These findings suggest an association between non-depleting induction immunosuppression and less clinically significant ACR in pediatric patients undergoing cardiac transplantation. Differences in baseline characteristics Characteristic No Induction Daclizumab Basiliximab P Time period 1983-2001 2001-2009 2009-2011 - Recipient age in years, mean 5.1 9 7.3 0.07 White race, % 87.5 40.7 58.3 0.01 Female donor into Male recipient, % 50 36 0 0.02 Black donor into White recipient, % 55 0 33 0.007 Donor age in years, mean 27.3 11 7.1 0.01