title: Induction with anti-thymocyte globulin in heart transplantation is associated with better long-term survival compared with basiliximab.
abstract: BACKGROUND
  The use of induction therapy may reduce the risk of acute rejection after heart transplantation. This study assessed the association between basiliximab (BAS) vs anti-thymocyte globulin (ATG) induction and long-term survival after heart transplantation.
  
  
  METHODS
  We used data from the International Society for Heart and Lung Transplantation Registry to examine outcomes of all adult heart transplant recipients treated with ATG or BAS as induction therapy.
  
  
  RESULTS
  We identified 9,324 transplantations performed between 2000 and 2011 whose recipients received ATG (n = 6,144) or BAS (n = 3,180). The ATG group had a higher panel reactive antibody class 1 (7.5% vs 6.1%; p < 0.018) and class 2 (6.6% vs 3.7%; p < 0.001), respectively, whereas the BAS group was less likely to have non-ischemic cardiomyopathy but more likely to be in the intensive care unit pre-transplant. One-year survival was similar for both groups, 90% vs 91% (p = 0.858). However, use of BAS was associated with poorer long-term survival compared with ATG at 5 years (77% vs 82%, p = 0.005) and at 10 years (64% vs 67%, p = 0.007). In multivariable Cox model, use of BAS remained associated with increased mortality over a median follow-up of 3.0 years (range, 0-12 years), with a hazard ratio of 1.22 (95% confidence interval, 1.09-1.37; p < 0.001). Sub-group analyses showed BAS was not independently associated with increased risk in those who received a previous transplant or in those who underwent re-transplantation due to graft failure.
  
  
  CONCLUSIONS
  In the International Society for Heart and Lung Transplantation Registry experience, use of ATG rather than BAS as induction therapy appears to be associated with better long-term survival. A prospective study is necessary to confirm these findings.
authors.affiliation: Cardiothoracic Surgery, Department of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Ansari
authors.affiliation: Unit of Cardiology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lund
authors.affiliation: The Department of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
authors.affiliation: Surgery, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden.
authors.forename: Bodil
authors.initials: B
authors.lastname: Andersson
authors.affiliation: Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, Lund, Lund University and Skåne University Hospital, Lund, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Höglund
authors.affiliation: The International Society for Heart and Lung Transplantation Transplant Registry, Dallas, Texas.
authors.forename: Leah
authors.initials: L
authors.lastname: Edwards
authors.affiliation: Cardiothoracic Surgery, Department of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden. Electronic address: johan.nilsson@med.lu.se.
authors.forename: Johan
authors.initials: J
authors.lastname: Nilsson
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D000077552:Basiliximab; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D006084:Graft Rejection / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012042:Registries; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab
keywords: ATG; anti-thymocyte globulin; basiliximab; cardiovascular-related death; graft failure; heart transplantation; infection-related death; mortality