title: Effect of Induction Therapy on Graft Survival in Primary Pediatric Heart Transplantation: A Propensity Score Analysis of the UNOS Database.
abstract: The use of induction therapy in pediatric heart transplantation has increased. The aim of this study was to investigate the effects of induction therapy on graft survival.
  
  
  
  The United Network for Organ Sharing database was queried for isolated pediatric heart transplants from January 1, 1994, to December 31, 2013. Propensity scores for induction treatment were calculated by estimating probability of induction using a logistic regression model. Transplants were then matched between induction treatment groups based on the propensity score, reducing potential biases. Using only propensity score matched transplants, the effect of induction therapy on graft survival was investigated using Cox-proportional hazards. Subgroup analyses were performed based on age, race, recipient cardiac diagnosis, HLA, and recipient panel-reactive antibody (PRA).
  
  
  
  Of 4565 pediatric primary heart transplants from 1994 to 2013, 3741 had complete data for the propensity score calculation. There were 2792 transplants successfully matched (induction, n = 1396; no induction, n = 1396). There were no significant differences in transplant and pretransplant covariates between induction and no induction groups. In the Cox-proportional hazards model, the use of induction of was not associated with graft loss (hazard ratio [HR], 0.88; 95% confidence interval [95% CI], 0.75-1.01; P = 0.07). In subgroup analyses, induction therapy may be associated with improved survival in patients with PRA greater than 50% (HR, 0.57; 95% CI, 0.34-0.97) and congenital heart disease (HR, 0.78; 95% CI, 0.64-0.96).
  
  
  
  Induction therapy is not associated with improved graft survival in primary pediatric heart transplantation. However, in pediatric heart transplant recipients with PRA greater than 50% or congenital heart disease, induction therapy is associated with improved survival.
authors.affiliation: 1 Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC. 2 Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC. 3 Department of Transplant Services, Medical University of South Carolina, Charleston, SC. 4 Department of Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Ryan
authors.initials: R
authors.lastname: Butts
authors.forename: Melanie
authors.initials: M
authors.lastname: Davis
authors.forename: Andrew
authors.initials: A
authors.lastname: Savage
authors.forename: Ali
authors.initials: A
authors.lastname: Burnette
authors.forename: Minoo
authors.initials: M
authors.lastname: Kavarana
authors.forename: Scott
authors.initials: S
authors.lastname: Bradley
authors.forename: Andrew
authors.initials: A
authors.lastname: Atz
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004334:Drug Administration Schedule; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D060828:Induction Chemotherapy / Q000009:adverse effects / Q000379:methods*; D007223:Infant; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States
chemical_list: D007166:Immunosuppressive Agents