A contemporary analysis of induction immunosuppression in pediatric lung transplant recipients

Don Hayes, Stephen Kirkby, Allison M. Wehr, Amy M. Lehman, Patrick I. McConnell, Mark Galantowicz, Robert Higgins, Bryan A. Whitson

Research output: Contribution to journalArticle

Abstract

There is an increasing trend in the use of induction immunosuppression in children undergoing lung transplantation (LTx). To evaluate the effect of this practice on survival, the United Network for Organ Sharing (UNOS) was queried from 1987 to 2012, restricting analysis to transplant patients 6-17 years old from 2001 to 2012, who received no induction (NONE) or induction (INDUCED) with the contemporary agents of basiliximab, alemtuzumab, thymoglobulin, antilymphocyte globulin (ALG), or antithymocyte globulin (ATG). Of 23 951 lung transplants, 330 met inclusion criteria with 177 (54%) being INDUCED. Of the INDUCED agents, 121 (68%) were basiliximab, 3 (2%) alemtuzumab, and 53 (30%) ALG/ATG/thymoglobulin. The mean patient age was 13.6 (SD = 3.2) and 14 (SD = 3.0) years for the INDUCED and NONE groups, respectively. The median survival in the INDUCED group was 77.4 months (95% CI: 46.1, 125.6) compared with 50.8 months (95% CI: 42.9, 61.3) for the NONE (log-rank P-value = 0.3601). The most common cause of death was due to allograft failure or pulmonary complications with only one patient dying from post-transplant lymphoproliferative disorder. The estimated hazard ratio for INDUCED versus NONE was 0.859 (95% CI: 0.620, 1.191; P = 0.3618); there were no significant confounders or effect modifiers among the demographic and clinical variables. In conclusion, antibody-based induction immunosuppression with contemporary agents had a trend toward a protective, but not statistically significant, effect in 6- to 17-year-old patients.

Original languageEnglish (US)
Pages (from-to)211-218
Number of pages8
JournalTransplant International
Volume27
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

Fingerprint

Antilymphocyte Serum
Immunosuppression
Pediatrics
Lung
Transplants
Survival
Lymphoproliferative Disorders
Lung Transplantation
Allografts
Cause of Death
Demography
Transplant Recipients
Antibodies
alemtuzumab
basiliximab
thymoglobulin

Keywords

  • children
  • immunosuppression
  • induction
  • lung transplantation
  • pediatric lung transplantation
  • survival

ASJC Scopus subject areas

  • Transplantation

Cite this

Hayes, D., Kirkby, S., Wehr, A. M., Lehman, A. M., McConnell, P. I., Galantowicz, M., ... Whitson, B. A. (2014). A contemporary analysis of induction immunosuppression in pediatric lung transplant recipients. Transplant International, 27(2), 211-218. https://doi.org/10.1111/tri.12240

A contemporary analysis of induction immunosuppression in pediatric lung transplant recipients. / Hayes, Don; Kirkby, Stephen; Wehr, Allison M.; Lehman, Amy M.; McConnell, Patrick I.; Galantowicz, Mark; Higgins, Robert; Whitson, Bryan A.

In: Transplant International, Vol. 27, No. 2, 02.2014, p. 211-218.

Research output: Contribution to journalArticle

Hayes, D, Kirkby, S, Wehr, AM, Lehman, AM, McConnell, PI, Galantowicz, M, Higgins, R & Whitson, BA 2014, 'A contemporary analysis of induction immunosuppression in pediatric lung transplant recipients', Transplant International, vol. 27, no. 2, pp. 211-218. https://doi.org/10.1111/tri.12240
Hayes D, Kirkby S, Wehr AM, Lehman AM, McConnell PI, Galantowicz M et al. A contemporary analysis of induction immunosuppression in pediatric lung transplant recipients. Transplant International. 2014 Feb;27(2):211-218. https://doi.org/10.1111/tri.12240
Hayes, Don ; Kirkby, Stephen ; Wehr, Allison M. ; Lehman, Amy M. ; McConnell, Patrick I. ; Galantowicz, Mark ; Higgins, Robert ; Whitson, Bryan A. / A contemporary analysis of induction immunosuppression in pediatric lung transplant recipients. In: Transplant International. 2014 ; Vol. 27, No. 2. pp. 211-218.
@article{b042e096a0514be7a6069ea92dbae74c,
title = "A contemporary analysis of induction immunosuppression in pediatric lung transplant recipients",
abstract = "There is an increasing trend in the use of induction immunosuppression in children undergoing lung transplantation (LTx). To evaluate the effect of this practice on survival, the United Network for Organ Sharing (UNOS) was queried from 1987 to 2012, restricting analysis to transplant patients 6-17 years old from 2001 to 2012, who received no induction (NONE) or induction (INDUCED) with the contemporary agents of basiliximab, alemtuzumab, thymoglobulin, antilymphocyte globulin (ALG), or antithymocyte globulin (ATG). Of 23 951 lung transplants, 330 met inclusion criteria with 177 (54{\%}) being INDUCED. Of the INDUCED agents, 121 (68{\%}) were basiliximab, 3 (2{\%}) alemtuzumab, and 53 (30{\%}) ALG/ATG/thymoglobulin. The mean patient age was 13.6 (SD = 3.2) and 14 (SD = 3.0) years for the INDUCED and NONE groups, respectively. The median survival in the INDUCED group was 77.4 months (95{\%} CI: 46.1, 125.6) compared with 50.8 months (95{\%} CI: 42.9, 61.3) for the NONE (log-rank P-value = 0.3601). The most common cause of death was due to allograft failure or pulmonary complications with only one patient dying from post-transplant lymphoproliferative disorder. The estimated hazard ratio for INDUCED versus NONE was 0.859 (95{\%} CI: 0.620, 1.191; P = 0.3618); there were no significant confounders or effect modifiers among the demographic and clinical variables. In conclusion, antibody-based induction immunosuppression with contemporary agents had a trend toward a protective, but not statistically significant, effect in 6- to 17-year-old patients.",
keywords = "children, immunosuppression, induction, lung transplantation, pediatric lung transplantation, survival",
author = "Don Hayes and Stephen Kirkby and Wehr, {Allison M.} and Lehman, {Amy M.} and McConnell, {Patrick I.} and Mark Galantowicz and Robert Higgins and Whitson, {Bryan A.}",
year = "2014",
month = "2",
doi = "10.1111/tri.12240",
language = "English (US)",
volume = "27",
pages = "211--218",
journal = "Transplant International",
issn = "0934-0874",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - A contemporary analysis of induction immunosuppression in pediatric lung transplant recipients

AU - Hayes, Don

AU - Kirkby, Stephen

AU - Wehr, Allison M.

AU - Lehman, Amy M.

AU - McConnell, Patrick I.

AU - Galantowicz, Mark

AU - Higgins, Robert

AU - Whitson, Bryan A.

PY - 2014/2

Y1 - 2014/2

N2 - There is an increasing trend in the use of induction immunosuppression in children undergoing lung transplantation (LTx). To evaluate the effect of this practice on survival, the United Network for Organ Sharing (UNOS) was queried from 1987 to 2012, restricting analysis to transplant patients 6-17 years old from 2001 to 2012, who received no induction (NONE) or induction (INDUCED) with the contemporary agents of basiliximab, alemtuzumab, thymoglobulin, antilymphocyte globulin (ALG), or antithymocyte globulin (ATG). Of 23 951 lung transplants, 330 met inclusion criteria with 177 (54%) being INDUCED. Of the INDUCED agents, 121 (68%) were basiliximab, 3 (2%) alemtuzumab, and 53 (30%) ALG/ATG/thymoglobulin. The mean patient age was 13.6 (SD = 3.2) and 14 (SD = 3.0) years for the INDUCED and NONE groups, respectively. The median survival in the INDUCED group was 77.4 months (95% CI: 46.1, 125.6) compared with 50.8 months (95% CI: 42.9, 61.3) for the NONE (log-rank P-value = 0.3601). The most common cause of death was due to allograft failure or pulmonary complications with only one patient dying from post-transplant lymphoproliferative disorder. The estimated hazard ratio for INDUCED versus NONE was 0.859 (95% CI: 0.620, 1.191; P = 0.3618); there were no significant confounders or effect modifiers among the demographic and clinical variables. In conclusion, antibody-based induction immunosuppression with contemporary agents had a trend toward a protective, but not statistically significant, effect in 6- to 17-year-old patients.

AB - There is an increasing trend in the use of induction immunosuppression in children undergoing lung transplantation (LTx). To evaluate the effect of this practice on survival, the United Network for Organ Sharing (UNOS) was queried from 1987 to 2012, restricting analysis to transplant patients 6-17 years old from 2001 to 2012, who received no induction (NONE) or induction (INDUCED) with the contemporary agents of basiliximab, alemtuzumab, thymoglobulin, antilymphocyte globulin (ALG), or antithymocyte globulin (ATG). Of 23 951 lung transplants, 330 met inclusion criteria with 177 (54%) being INDUCED. Of the INDUCED agents, 121 (68%) were basiliximab, 3 (2%) alemtuzumab, and 53 (30%) ALG/ATG/thymoglobulin. The mean patient age was 13.6 (SD = 3.2) and 14 (SD = 3.0) years for the INDUCED and NONE groups, respectively. The median survival in the INDUCED group was 77.4 months (95% CI: 46.1, 125.6) compared with 50.8 months (95% CI: 42.9, 61.3) for the NONE (log-rank P-value = 0.3601). The most common cause of death was due to allograft failure or pulmonary complications with only one patient dying from post-transplant lymphoproliferative disorder. The estimated hazard ratio for INDUCED versus NONE was 0.859 (95% CI: 0.620, 1.191; P = 0.3618); there were no significant confounders or effect modifiers among the demographic and clinical variables. In conclusion, antibody-based induction immunosuppression with contemporary agents had a trend toward a protective, but not statistically significant, effect in 6- to 17-year-old patients.

KW - children

KW - immunosuppression

KW - induction

KW - lung transplantation

KW - pediatric lung transplantation

KW - survival

UR - http://www.scopus.com/inward/record.url?scp=84892369206&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892369206&partnerID=8YFLogxK

U2 - 10.1111/tri.12240

DO - 10.1111/tri.12240

M3 - Article

C2 - 24236829

AN - SCOPUS:84892369206

VL - 27

SP - 211

EP - 218

JO - Transplant International

JF - Transplant International

SN - 0934-0874

IS - 2

ER -