Induction Therapy for Lung Transplantation in COPD: Analysis of the UNOS Registry

Joseph S. Duffy, Dmitry Tumin, Amy Pope-Harman, Bryan A. Whitson, Robert S.D. Higgins, Don Hayes

Research output: Contribution to journalArticlepeer-review

Abstract

Although studies demonstrate that induction therapy improves outcomes after lung transplantation, its influence on survival in patients with chronic obstructive pulmonary disease (COPD) is not clear. The United Network for Organ Sharing database was queried to obtain data regarding adult patients with COPD receiving lung transplant between May 2005 and June 2014. Therapies evaluated include anti-thymocyte globulin, anti-lymphocyte globulin, thymoglobulin, basiliximab, and alemtuzumab. Data were categorized based on receiving induction (INDUCED) and no induction (NONE). Kaplan–Meier plots, Cox proportional hazards models of patient survival, and competing-risks regression models for secondary endpoints were utilized. A total of 3,405 patients who underwent lung transplantation for COPD were enrolled with 1,761 (52%) receiving induction therapy. Of INDUCED, 1,146 (65%) received basiliximab, 380 (22%) received alemtuzumab, and 235 (13%) received a polyclonal preparation. The hazard ratio for INDUCED vs. NONE was 0.793 (95% CI = 0.693, 0.909; p = 0.001) in the fully adjusted Cox model. A multivariable competing-risks model also found a protective influence of induction therapy with respect to delayed onset of bronchiolitis obliterans syndrome after transplantation (SHR = 0.801; 95% CI = 0.694, 0.925; p = 0.003). In a cohort of recently transplanted patients with COPD, there appears to be a benefit from contemporary induction agents with no concurrent increase in the risk of death due to infection.

Original languageEnglish (US)
Pages (from-to)647-652
Number of pages6
JournalCOPD: Journal of Chronic Obstructive Pulmonary Disease
Volume13
Issue number5
DOIs
StatePublished - Sep 2 2016

Keywords

  • chronic obstructive pulmonary disease
  • immunosuppression
  • induction
  • lung transplantation
  • mortality
  • survival

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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