title: Induction Therapy for Lung Transplantation in COPD: Analysis of the UNOS Registry.
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.
authors.affiliation: a Department of Internal Medicine , The Ohio State University School of Medicine , Columbus , Ohio , USA.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Duffy
authors.affiliation: c Departement of Pediatrics , The Ohio State University School of Medicine , Columbus , Ohio , USA.|f Department of Anesthesiology and Pain Medicine , Nationwide Children's Hospital , Columbus , Ohio , USA.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Tumin
authors.affiliation: a Department of Internal Medicine , The Ohio State University School of Medicine , Columbus , Ohio , USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Pope-Harman
authors.affiliation: b Department of Surgery , The Ohio State University School of Medicine , Columbus , Ohio , USA.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
authors.affiliation: d Department of Surgery , The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.
authors.forename: Robert S D
authors.initials: RS
authors.lastname: Higgins
authors.affiliation: a Department of Internal Medicine , The Ohio State University School of Medicine , Columbus , Ohio , USA.|b Department of Surgery , The Ohio State University School of Medicine , Columbus , Ohio , USA.|c Departement of Pediatrics , The Ohio State University School of Medicine , Columbus , Ohio , USA.|e Section of Pulmonary Medicine , Nationwide Children's Hospital , Columbus , OH , USA .
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
mesh_terms: D000368:Aged; D000074323:Alemtuzumab / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D000077552:Basiliximab; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D060828:Induction Chemotherapy; D007239:Infections / Q000209:etiology / Q000401:mortality; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States
chemical_list: D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000074323:Alemtuzumab; D000077552:Basiliximab; C512542:thymoglobulin
keywords: chronic obstructive pulmonary disease; immunosuppression; induction; lung transplantation; mortality; survival