The Impact of Induction Immunosuppression Agent on Retransplant-Free and Bronchiolitis Obliterans-Free Survival in Sensitized Lung Transplant Recipients.

There is significant variability in induction immunosuppression for sensitized (PRA≥1%) and highly sensitized (PRA>60%) lung transplant recipients. We compared retransplant-free and bronchiolitis obliterans (BOS)-free survival among sensitized recipients based on cytolytic versus interleukin-2 receptor antagonist (IL2-RA) versus corticosteroid only induction. This was a retrospective study sensitized adult lung transplant recipients in SRTR from 5/5/2005-5/31/2019. Subjects were categorized according to cytolytic (ATG, OKT3, alemtuzumab), IL2-RA (daclizumab, basiliximab), or corticosteroid-only induction. Cox proportional-hazard models were used to compare retransplant-free survival and BOS-free survival according to induction, adjusting for clinical covariates. Of the 5696 included recipients, 1281 (22.5%) received cytolytic, 3057 (53.7%) IL2-RA, and 908 (15.9%) corticosteroid-only induction. Compared to IL2-RA, cytolytic induction was associated with improved adjusted retransplant-free survival (HR=0.80, 95% CI=0.05-1.00, p=0.052) and improved adjusted BOS-free survival (HR=0.79, 95% CI=0.88-0.97, p=0.009) (Figure 1). Cytolytic induction was also associated with decreased need for plasmapheresis after index hospitalization (OR=0.47, p=0.04). Among highly sensitized recipients (n=712) cytolytic induction (n=161) was not associated with retransplant-free (p=0.51) or BOS-free survival (p=0.73) compared to IL2-RA (n=551). Among all sensitized recipients, the use of corticosteroid-only induction was associated with worse BOS-free survival (HR=1.19, 95% CI=1.08-1.31, p<0.001). The use of cytolytic induction compared to IL2-RA is associated with a small improvement in retransplant-free and BOS-free survival among sensitized lung transplant recipients. Corticosteroid-only induction is associated with worse BOS-free survival. [ABSTRACT FROM AUTHOR]