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 S. 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

Keywords

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

ASJC Scopus subject areas

  • Transplantation

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  • Cite this

    Hayes, D., Kirkby, S., Wehr, A. M., Lehman, A. M., McConnell, P. I., Galantowicz, M., Higgins, R. S., & 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