Retrospective Analysis of UNOS Database to Assess the Impact of Induction Therapy on Rejection in Heart Transplantation

Purpose Evidence suggests that routine induction therapy does not improve long-term survival post-heart transplantation. The aim of this study was to evaluate if induction therapy would decrease the risk of treated rejection. Methods A retrospective analysis of 33,922 patients ≥ 18 years old in the UNOS database who underwent heart transplantation 2000-2017 was performed. Patients with prior transplants and dual organ transplants were excluded. The primary end point was treated rejection at one year. Patients were divided into three groups: no induction, induction with IL-2 receptor antagonists (daclizumab and basiliximab) and induction with T-cell depleting agents (alemtuzumab and anti-thymocyte globulins). Results 51% did not receive induction, 25% received IL-2 receptor antagonists and 25% received T-cell depleting agents. Female sex and black race were associated with increased odds of treated rejection at one year (OR 1.321, p Conclusion Induction with T-cell depleting agents reduces the risk of treated rejection at one year. This effect was not seen with IL-2 receptor antagonists. Female sex, higher degrees of HLA mismatch and black race are associated with increased risk of rejection and induction with T-cell depleting antibodies may reduce the risk of treated rejection in this group.