Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
PURPOSE:In heart transplant, induction may allow for delay of calcineurin inhibitor initiation and renal recovery. Literature comparing lymphocyte-depleting and non-depleting induction conflicts in rejection rate and safety. We conducted a retrospective review of 165 patients to evaluate 3-month rates of infection, rejection, and readmission after a change in induction protocol.
METHODS:Adults who underwent heart transplant from Mar 2013 to Apr 2017 were included. Exclusion criteria were multi-organ transplant, re-transplant, and follow up at a Veteran's Affairs hospital. Protocol era was defined as early (anti-thymocyte globulin or no induction before Nov 2015) or current (basiliximab or no induction after Oct 2015). Multivariable logistic regression models that adjusted for age, panel reactive antibody, creatinine, induction use, and era by induction interaction effect evaluated the relationship between era and likelihood of events.
RESULTS:There were no differences in demographics or co-morbidities; more patients received induction in the early era.
|Early Protocol (N=78)||Current Protocol (N=87)||p-value|
|Age||53 (11)||53 (12)||0.782|
|Male||51 (65)||66 (76)||0.170|
|Caucasian||57 (73)||67 (77)||0.592|
|Ischemic Heart Disease||31 (40)||38 (44)||0.638|
|Diabetes||18 (23)||24 (28)||0.592|
|Hypertension||64 (82)||66 (76)||0.348|
|Chronic Kidney Disease||41 (53)||50 (58)||0.535|
|Ventricular Assist Device||60 (77)||65 (75)||0.856|
|No Induction||25 (32)||61 (71)||≤0.001|
|≥1 Event Within 3 Months|
|Infection||6 (8)||6 (8)||1.00|
|Rejection||23 (33)||36 (41)||0.335|
|Readmission||41 (53)||39 (45)||0.352|
Table entries: number of patients (%) or mean (SD) a P-values are not adjusted for relevant covariates
After adjusting for induction use and covariates, those transplanted in the early era were 3 times more likely to be readmitted (OR=3.04, 95% CI 1.07-8.70,p=0.038). Era was not related to likelihood of infection or rejection (p≥0.190).
CONCLUSION:Changing from using primarily thymoglobulin induction to a new protocol of mostly utilizing no induction was not associated with increased likelihood of infection or rejection; however, likelihood of readmission declined with the protocol change.
CITATION INFORMATION: Kush S., Boyle K., Gray J., Rega S., Feurer I., Shah A., Lindenfeld J. Less Induction Therapy Means Fewer Early Readmissions with No Change in Rejection or Infection Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Kush S, Boyle K, Gray J, Rega S, Feurer I, Shah A, Lindenfeld J. Less Induction Therapy Means Fewer Early Readmissions with No Change in Rejection or Infection [abstract]. https://atcmeetingabstracts.com/abstract/less-induction-therapy-means-fewer-early-readmissions-with-no-change-in-rejection-or-infection/. Accessed January 29, 2020.
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