title: To induce or not to induce: a 21st century evaluation of lung transplant immunosuppression's effect on survival.
abstract: BACKGROUND
  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).
  
  
  CONCLUSIONS
  In a contemporary analysis of lung transplant recipients, induction immunosuppression has a significantly positive effect on survival.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
authors.forename: Amy
authors.initials: A
authors.lastname: Lehman
authors.forename: Allison
authors.initials: A
authors.lastname: Wehr
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
authors.forename: Stephen
authors.initials: S
authors.lastname: Kirkby
authors.forename: Amy
authors.initials: A
authors.lastname: Pope-Harman
authors.forename: Ahmet
authors.initials: A
authors.lastname: Kilic
authors.forename: Robert S D
authors.initials: RS
authors.lastname: Higgins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D060828:Induction Chemotherapy / Q000379:methods*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents
keywords: immunosuppression; induction; lung transplant; outcome; survival