title: Induction immunosuppression for combined heart-lung transplantation.
abstract: Research on induction immunosuppression in patients undergoing combined heart-lung transplantation (HLTx) is limited.
  
  
  
  The United Network for Organ Sharing database was queried from 2000 to 2013 to examine the influence of induction immunosuppression for combined HLTx in adult (≥18 years) and adolescent (≥12 and <18 years) recipients.
  
  
  
  Of 394 eligible combined HLTx cases (361 adults, 33 adolescents), 384 were included in univariate Cox analysis and 116 in the multivariate Cox model. Univariate analysis demonstrated no differences in survival by induction medication and no difference among the most common maintenance immunosuppression regimens. Adjusting for use of corticosteroids, multivariate analysis demonstrated no benefit of basiliximab (HR=3.582; 95% CI: 0.966, 13.279; P=.056), thymoglobulin/antilymphocyte globulin (ALG)/antithymocyte globulin (ATG) (HR=0.808; 95% CI: 0.134, 4.888; P=.817), alemtuzumab (HR=0.369; 95% CI: 0.087, 1.563; P=.176), or other induction medications (HR=1.511; 95% CI: 0.146, 15.610; P=.729), compared to no induction medication, with respect to mortality hazard post-HLTx. There were also no differences in treated acute rejection episodes by type of induction immunosuppression.
  
  
  
  Induction immunosuppression with contemporary agents does not improve survival after combined HLTx.
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. hayes.705@osu.edu.|Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA. hayes.705@osu.edu.|Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA. hayes.705@osu.edu.|Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, OH, USA. hayes.705@osu.edu.|Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA. hayes.705@osu.edu.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
authors.affiliation: Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.|Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Patrick I
authors.initials: PI
authors.lastname: McConnell
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.|Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, OH, USA.|Section of Cardiology, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Yates
authors.affiliation: Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA.|Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.affiliation: Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.|Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Galantowicz
authors.affiliation: Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, OH, USA.|The University of Arizona Colleges of Pharmacy and Medicine, Tucson, AZ, USA.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Mansour
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.|Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Tumin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality / Q000517:prevention & control*; D016041:Heart-Lung Transplantation / Q000401:mortality*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D060828:Induction Chemotherapy / Q000379:methods*; D053208:Kaplan-Meier Estimate; D060046:Maintenance Chemotherapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: adolescents; adults; heart and lung transplantation; immunosuppression; induction; survival