Induction with anti-thymocyte globulin in heart transplantation is associated with better long-term survival compared...

The use of induction therapy may reduce the risk of acute rejection after heart transplantation. This study assessed the association between basiliximab (BAS) vs anti-thymocyte globulin (ATG) induction and long-term survival after heart transplantation.

We used data from the International Society for Heart and Lung Transplantation Registry to examine outcomes of all adult heart transplant recipients treated with ATG or BAS as induction therapy.

We identified 9,324 transplantations performed between 2000 and 2011 whose recipients received ATG (n = 6,144) or BAS (n = 3,180). The ATG group had a higher panel reactive antibody class 1 (7.5% vs 6.1%; p < 0.018) and class 2 (6.6% vs 3.7%; p < 0.001), respectively, whereas the BAS group was less likely to have non-ischemic cardiomyopathy but more likely to be in the intensive care unit pre-transplant. One-year survival was similar for both groups, 90% vs 91% (p = 0.858). However, use of BAS was associated with poorer long-term survival compared with ATG at 5 years (77% vs 82%, p = 0.005) and at 10 years (64% vs 67%, p = 0.007). In multivariable Cox model, use of BAS remained associated with increased mortality over a median follow-up of 3.0 years (range, 0-12 years), with a hazard ratio of 1.22 (95% confidence interval, 1.09-1.37; p < 0.001). Sub-group analyses showed BAS was not independently associated with increased risk in those who received a previous transplant or in those who underwent re-transplantation due to graft failure.

In the International Society for Heart and Lung Transplantation Registry experience, use of ATG rather than BAS as induction therapy appears to be associated with better long-term survival. A prospective study is necessary to confirm these findings.