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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.