title: The Impact of Alemtuzumab and Basiliximab Induction on Patient Survival and Time to Bronchiolitis Obliterans Syndrome in Double Lung Transplantation Recipients.
abstract: We examined the effect of alemtuzumab and basiliximab induction therapy on patient survival and freedom from bronchiolitis obliterans syndrome (BOS) in double lung transplantation. The United Network for Organ Sharing database was reviewed for adult double lung transplant recipients from 2006 to 2013. The primary outcome was risk-adjusted all-cause mortality. Secondary outcomes included time to BOS. There were 6117 patients were identified, of whom 738 received alemtuzumab, 2804 received basiliximab, and 2575 received no induction. Alemtuzumab recipients had higher lung allocation scores compared with basiliximab and no-induction recipients (41.4 versus 37.9 versus 40.7, p < 0.001) and were more likely to require mechanical ventilation before to transplantation (21.7% versus 6.5% versus 6.2%, p < 0.001). Median survival was longer for alemtuzumab and basiliximab recipients compared with patients who received no induction (2321 versus 2352 versus 1967 days, p = 0.001). Alemtuzumab (hazard ratio 0.80, 95% confidence interval 0.67-0.95, p = 0.009) and basiliximab induction (0.88, 0.80-0.98, p = 0.015) were independently associated with survival on multivariate analysis. At 5 years, alemtuzumab recipients had a lower incidence of BOS (22.7% versus 55.4 versus 55.9%), and its use was independently associated with lower risk of developing BOS on multivariate analysis. While both induction therapies were associated with improved survival, patients who received alemtuzumab had greater median freedom from BOS.
authors.affiliation: Division of Pulmonary & Critical Care, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: Y
authors.initials: Y
authors.lastname: Furuya
authors.affiliation: Department of Surgery, Section of Vascular Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: S N
authors.initials: SN
authors.lastname: Jayarajan
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: S
authors.initials: S
authors.lastname: Taghavi
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA.
authors.forename: F C
authors.initials: FC
authors.lastname: Cordova
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA.
authors.forename: N
authors.initials: N
authors.lastname: Patel
authors.affiliation: Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA.
authors.forename: A
authors.initials: A
authors.lastname: Shiose
authors.affiliation: Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA.
authors.forename: E
authors.initials: E
authors.lastname: Leotta
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA.
authors.forename: G J
authors.initials: GJ
authors.lastname: Criner
authors.affiliation: Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA.
authors.forename: T S
authors.initials: TS
authors.lastname: Guy
authors.affiliation: Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA.
authors.forename: G H
authors.initials: GH
authors.lastname: Wheatley
authors.affiliation: Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA.
authors.forename: L R
authors.initials: LR
authors.lastname: Kaiser
authors.affiliation: Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA.
authors.forename: Y
authors.initials: Y
authors.lastname: Toyoda
mesh_terms: D000328:Adult; D000074323:Alemtuzumab / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000077552:Basiliximab; D001989:Bronchiolitis Obliterans / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D060828:Induction Chemotherapy; D008171:Lung Diseases / Q000401:mortality* / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012307:Risk Factors; D013577:Syndrome
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000074323:Alemtuzumab; D000077552:Basiliximab
keywords: bronchiolitis obliterans (BOS); clinical research/practice; fusion proteins and monoclonal antibodies: alemtuzumab; fusion proteins and monoclonal antibodies: basiliximab/daclizumab; health services and outcomes research; immunosuppressant; immunosuppression/immune modulation; immunosuppressive regimens; induction; lung (allograft) function/dysfunction; lung transplantation/pulmonology