Impact of induction therapy on outcomes after heart transplantation.

Background Approximately 50% of heart transplant (HT) programs utilize induction therapy (IT) with interleukin-2 receptor antagonists (IL2RA) or polyclonal anti-thymocyte antibodies (ATG). Methods Adult HT recipients were identified in the UNOS Registry between 2010 and 2020. We compared mortality between IT strategies with competing risk analysis. Results A total of 28,634 HT recipients were included in the study (50.1% no IT, 21.3% ATG, 27.9% IL2RA, 0.7% alemtuzumab, 0.01% OKT3). Adjusted all-cause, 30 day and 1 year mortality were lower among those treated with IT than no IT (sub-hazard ratio [SHR] 0.87, 95% CI 0.79-0.96, SHR 0.86, 0.76-0.97, SHR 0.76, 0.63-0.93, p = 0.007 respectively). In propensity score matching analysis IT was associated with lower 30-day and 1-year mortality. IL2RA had higher all-cause and 1-year mortality than ATG (SHR 1.41, 95% CI 1.23-1.69 and 1.55, 95% CI 1.29-1.88 respectively). Utilization of IT was associated with significantly lower risk of treated rejection at one year after HT compared with no IT (relative risk ratio [RRR] 0.79) and similarly ATG compared with IL2RA (RRR 0.51). Conclusion IT was associated with lower mortality and treated rejection episodes than no IT. IL2RA is the most used IT approach but ATG has lower risk of treated rejection and mortality. This article is protected by copyright. All rights reserved.