The impact of induction on survival after lung transplantation: an analysis of the International Society for Heart and Lung Transplantation Registry.
BACKGROUND
The use of induction immunosuppression after lung transplantation remains controversial. In this study, we examined the impact of induction on survival after lung transplantation.


METHODS
We performed a retrospective cohort study of 3970 adult lung transplant recipients reported to the ISHLT Registry. We divided the cohort into three groups based on the use of induction: none, interleukin-2 receptor antagonists (IL-2 RA), and polyclonal antithymocyte globulins (ATG). We estimated graft survival using the Kaplan-Meier method and constructed a multivariable Cox proportional hazards model to examine the impact of induction on graft survival in the context of other variables.


RESULTS
During the study period, 2249 patients received no induction, 1124 received IL-2 RA, and 597 received ATG. Four years after transplantation, recipients treated with IL-2 RA had better graft survival (64%) than those treated with ATG (60%) and those who did not receive induction (57%; log rank p = 0.0067). This survival advantage persisted in the multivariable model for single and bilateral recipients treated with IL-2 RA compared to those who did not receive induction (RR = 0.82, p = 0.007). Similarly, bilateral recipients treated with ATG had a survival advantage over bilateral recipients who did not receive induction (RR = 0.78, p = 0.043), but single lung recipients treated with ATG did not have a survival advantage over single lung recipients who did not receive induction (RR = 1.06, p = 0.58).


CONCLUSIONS
Induction with lL-2 RA for single and bilateral lung recipients and induction with ATG for bilateral recipients are associated with a survival benefit, independent of other variables that might impact survival.
Hachem
Ramsey R
RR
Division of Pulmonary & Critical Care, Washington University School of Medicine, St. Louis, MO, USA. rhachem@im.wustl.edu
Edwards
Leah B
LB
Yusen
Roger D
RD
Chakinala
Murali M
MM
Alexander Patterson
G
G
Trulock
Elbert P
EP
D000961:Antilymphocyte Serum / Q000009:adverse effects*; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016040:Lung Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D015375:Receptors, Interleukin-2 / Q000037:antagonists & inhibitors*; D012042:Registries; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2