Survival benefit of induction immunosuppression in cystic fibrosis lung transplant recipients

J Cyst Fibros. 2015 Jan;14(1):104-10. doi: 10.1016/j.jcf.2014.05.010. Epub 2014 Jun 16.

Abstract

Background: Despite resistant microbes, induction immunosuppression is used in patients with cystic fibrosis (CF) undergoing lung transplantation (LTx).

Methods: To evaluate the effect of induction immunosuppression on survival, the United Network for Organ Sharing (UNOS) was queried restricting analysis to transplant patients 6-55years old from 2001 to 2012, who received induction agents (INDUCED) or did not (NONE).

Results: A total of 1721 CF patients who underwent LTx were included in the analysis; of these 791 (46%) were INDUCED. Of the INDUCED patients, 65% received basiliximab, 10% alemtuzumab, and 25% thymoglobulin/anti-lymphocyte globulin/anti-thymocyte globulin. Mean age was 28.0years (SD=9.7) and 28.5 (SD=9.5) for the INDUCED and NONE groups, respectively. The median survival in the INDUCED group was 93.8months (95% CI: 73.8, --) compared to 61.8months (95% CI: 55.8-73.8) for the NONE group (log rank p-value <0.001).

Conclusions: Antibody-based induction immunosuppression had a survival benefit in CF patients undergoing LTx.

Keywords: Cystic fibrosis; Immunosuppression; Induction; Lung transplantation; Survival.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Alemtuzumab
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal, Humanized / administration & dosage
  • Antilymphocyte Serum / administration & dosage
  • Basiliximab
  • Child
  • Cohort Studies
  • Cystic Fibrosis / diagnosis
  • Cystic Fibrosis / immunology
  • Cystic Fibrosis / surgery*
  • Databases, Factual
  • Female
  • Graft Rejection
  • Graft Survival
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Kaplan-Meier Estimate
  • Lung Transplantation / methods
  • Lung Transplantation / mortality*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Proportional Hazards Models
  • Recombinant Fusion Proteins / administration & dosage
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Survival Analysis
  • Time Factors
  • Transplant Recipients / statistics & numerical data
  • Transplantation Immunology*
  • Treatment Outcome
  • Young Adult

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antilymphocyte Serum
  • Immunosuppressive Agents
  • Recombinant Fusion Proteins
  • Alemtuzumab
  • Basiliximab
  • thymoglobulin