To induce or not to induce: A 21st century evaluation of lung transplant immunosuppression's effect on survival

Bryan A. Whitson, Amy Lehman, Allison Wehr, Don Hayes, Stephen Kirkby, Amy Pope-Harman, Ahmet Kilic, Robert S.D. Higgins

Research output: Contribution to journalArticle

Abstract

Introduction: The impact of induction immunosuppression on long-term survival in lung transplant recipients remains unclear. We sought to evaluate the effect of contemporary induction immunosuppression agents in lung transplant recipients' survival, utilizing national registry data. Methods: We queried the United Network for Organ Sharing registry from 2001 to 2012 for adult, deceased donor lung transplants who received no antibody-based induction (NONE) or the contemporary agents of basiliximab, alemtuzumab, thymoglobulin, antilymphocyte globulin, or antithymocyte globulin (INDUCED). Kaplan-Meier estimates of the survival and Cox proportional hazards models assessed differences in overall survival between the INDUCED and NONE groups; logistic regression models assessed differences in survival and rejection (TR1Y). Results: There were 23 951 lung transplants performed with 12 858 meeting the inclusion criteria; 5713 (44%) were INDUCED. Of INDUCED agents, 62% were basiliximab and 14% alemtuzumab. Being INDUCED significantly increased overall survival (p < 0.0001). Median INDUCED survival was 71.3 months (confidence interval [CI]: 65.7-75.5) as compared with 63.2 months (CI: 60.1-65.9). Of INDUCED, both basiliximab and alemtuzumab had higher median survival times at 75.1 months (CI: 68.6-81.3) and 75.5 months (CI: 63.5-∞), respectively. There was less TR1Y in INDUCED patients (37%), as compared to NONE (42%; p < 0.0001). Conclusion: In a contemporary analysis of lung transplant recipients, induction immunosuppression has a significantly positive effect on survival.

Original languageEnglish (US)
Pages (from-to)450-461
Number of pages12
JournalClinical Transplantation
Volume28
Issue number4
DOIs
StatePublished - Apr 2014
Externally publishedYes

Keywords

  • Immunosuppression
  • Induction
  • Lung transplant
  • Outcome
  • Survival

ASJC Scopus subject areas

  • Transplantation

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