Impact of induction strategy change on first‐year rejection in pediatric heart transplantation at a single center—From postoperative basiliximab to either postoperative anti‐thymocyte globulin or preoperative basiliximab. Issue 6 (25th April 2021)

• Record Type: Journal Article
• Authors: Sisson, Thomas Miller; Padilla, Luz A.; Hubbard, Meloneysa; Smith, Sally; Pearce, Frank Bennett; Collins, Jacqueline Leslie; Carlo, Waldemar F.
• Is Part Of: Clinical transplantation. Volume 35:Issue 6(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-04-25
• Subjects: anti‐thymocyte globulin -- basiliximab -- induction -- pediatric heart transplant; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.14314
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Background: Our pediatric heart transplant center transitioned from post‐bypass basiliximab (BAS) induction to either anti‐thymocyte globulin (ATG) or pre‐bypass BAS. The purpose of this study was to compare first‐year rejection rates before and after this change. Methods: A single‐center retrospective analysis was conducted of pediatric heart transplant recipients from 2010 to 2019. Primary outcome was first‐year rejection. Bivariate analysis, Kaplan‐Meier curves, and multivariable regression were performed across eras. Results: Forty‐three early era patients (55%) received post‐bypass BAS, and 35 late era patients (45%) received pre‐bypass BAS ( n = 17) or ATG ( n = 18). First‐year rejection decreased in the late era (31% vs 53%, p = .05). This finding was more pronounced after excluding infants (38% vs 73%, p = .006). Late era was associated with a decreased likelihood of rejection (all cohort OR 0.19, 95% CI 0.05‐0.66; infants excluded OR 0.17, 95% CI 0.04‐0.61). No differences in post‐transplant lymphoproliferative disease, donor‐specific antibody, or infection were observed. Conclusions: Fewer late era patients receiving ATG or pre‐bypass BAS induction had first‐year rejection compared to the early era patients receiving standard post‐bypass BAS induction. This programmatic shift in induction strategy was readily achievable and potentially effective in reducing first‐year rejection.