Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
To evaluate the impact of alemtuzumab, basiliximab and no induction therapy on patient survival and chronic rejection.
3242 adult single lung transplantation from 2006 to 2013 in UNOS database were reviewed. The primary outcome measured was risk-adjusted mortality. Secondary outcomes included time to brochiolitis obliterans syndrome (BOS).
1832 (56.5%) received no induction therapy, 215 (6.6%) received alemtuzumab induction, and 1195 (36.9%) received basiliximab induction. Patients who received alemtuzumab induction were older (64.3 years vs. No induction 61.3; Basiliximab 61.5; p<.0001), were more likely to have IPF (62.8%, No induction 51.2, Basiliximab 50.0; p<.0001), and less likely to have COPD (20.5%, No induction 29.4, Basiliximab 28.9; p<.0001). Alemtuzumab recipients had donors that were older (37.2 years, No induction 34.3, Basiliximab 33.8; p=0.006).
Alemtuzumab recipients had longer mean ischemic time (4.6 hours vs. No induction 4.3, Basiliximab 4.2; p=0.001), were more likely to be on mechanical ventilation (10.2% vs. No induction 3.9, Basiliximab 2.9; p<.0001) and ECMO (2.3% vs. No induction 1.0, Basiliximab 0.1; p=0.0004).
Alemtuzumab recipients had the longest length of stay (29.3 vs. No induction 21.4, Basiliximab 20.2; p=0.0001), and the longest median time to BOS (2545 days vs. No induction 1208, Basiliximab 1436; p<.0001). The difference in median survival time was not statistically significant (Alemtuzumab 1465 days, No induction 1465, Basiliximab 1651; p=0.367).
In the multivariate analysis, the use of alemtuzuamb as an induction agent was associated with survival (HR 0.78, 95% CI 0.63-0.98). Other variables which were associated with mortality include race mismatch (HR 1.2; 95% CI 1.06-1.36), mechanical ventilation at the time of transplant (HR 2.2; 95% CI 1.68-2.87), and ECMO at the time of transplantation (HR 2.0; 95% CI 1.08-3.70).
The use of alemtuzumab induction was associated with the longest time to BOS, as well as survival. This study supports the use of alemtuzumab induction in single lung transplant recipients.
To cite this abstract in AMA style:Furuya Y, Jayarajan S, Taghavi S, Ambur V, Cordova F, Patel N, Toyoda Y. The Impact of Alemtuzumab and Basiliximab Induction On Patient and Graft Survival in Single Lung Transplant Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-alemtuzumab-and-basiliximab-induction-on-patient-and-graft-survival-in-single-lung-transplant-recipients/. Accessed November 30, 2020.
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