Comparison of Basiliximab and Anti-Thymocyte Globulin as Induction Therapy in Pediatric Heart Transplantation: A Survival Analysis

Background-Basiliximab and anti-thymocyte globulin are widely used drugs for induction therapy after pediatric heart transplantation. The aim of this study was to determine whether any differences could be observed between basiliximab and anti-thymocyte globulin, with respect to long-term mortality, in a population of pediatric cardiac transplant recipients. Methods and Results-An analysis of pediatric heart transplant patients (aged < 18 years) from the United Network for Organ Sharing database was conducted that compared patients receiving basiliximab with those that received anti-thymocyte globulin for the risk of all-cause mortality. Secondary endpoints included death attributable to graft failure, cardiovascular causes, infection, or malignancy. Of the 2275 patients, 685 received basiliximab and 1590 anti-thymocyte globulin. One-year survival was similar for both groups; however, at 5 and 10 years, basiliximab was associated with poorer long-term survival (68% versus 76% at 5 years [P< 0.001] and 49% versus 65% at 10 years [P< 0.001], respectively). Basiliximab was associated with higher risk of death attributable to graft failure (P= 0.013), but not death attributable to cardiovascular causes (P= 0.444), infection (P= 0.095), or malignancy (P= 0.392). After multivariate analysis, use of basiliximab (versus use of anti-thymocyte globulin) remained significantly associated with all-cause mortality (hazard ratio, 1.27; 95% confidence interval, 1.02-1.57; P= 0.030). Conclusions-In pediatric heart transplant patients, use of basiliximab for induction therapy was associated with an increased risk of mortality, when compared with those receiving anti-thymocyte globulin.