Induction therapy confers survival advantage in mechanically supported patients regardless of peak CPRA in heart transplantation
Background: There is no consensus regarding induction therapy in patients on mechanically circulatory support (MCS) listed for heart transplantation. We sought to elucidate differences in outcomes between no induction and induction. Methods: A total of 3,987 patients were analyzed from the UNOS data...
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Elsevier
2025-05-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425000412 |
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| author | Nataliya Bahatyrevich, MD, MS Reid Dale, PhD Matthew Leipzig, BSc Katharine Casselman Pines, MPH Shirin Jimenez, MD Maria Currie, MD, PhD |
| author_facet | Nataliya Bahatyrevich, MD, MS Reid Dale, PhD Matthew Leipzig, BSc Katharine Casselman Pines, MPH Shirin Jimenez, MD Maria Currie, MD, PhD |
| author_sort | Nataliya Bahatyrevich, MD, MS |
| collection | DOAJ |
| description | Background: There is no consensus regarding induction therapy in patients on mechanically circulatory support (MCS) listed for heart transplantation. We sought to elucidate differences in outcomes between no induction and induction. Methods: A total of 3,987 patients were analyzed from the UNOS database from January 2018 through December 2022. Patients on Extracorporeal Membrane Oxygenation (ECMO), HeartMate 3, Impella 5.0 or 5.5, and intra-aortic balloon pump (IABP) and receiving no induction, anti-IL2R antibodies, or T cell depleting agent (TCDA) were included. Results: Of 3,987 patients, 1,288 (32.3%) received no induction, 1,566 (39.3%) received anti-IL2R antibodies, and 1,133 (28.4%) received TCDA. A total of 1,895 (47.5%) were supported with IABP; 1,098 (27.5%) with HeartMate 3; 489 (12.3%) with Impella 5.0 or 5.5; 351 (8.8%) with ECMO; and 154 (3.9%) with combination of the above devices. Comparison of 1-year survival between no induction, anti-IL2R, and TCDA groups in all MCS patients revealed significantly worse survival among those receiving no induction (p<0.0001). Subgroup analysis of peak CPRA 0% patients revealed that no induction had significantly worse survival at 1 year (p=0.002). Analysis of acute rejection at 1 year showed a significantly decreased number of rejection episodes in the TCDA group compared to no induction (OR 0.65, CI 0.47-0.88, p=0.006). Conclusions: Patients requiring MCS prior to heart transplantation have significantly improved post-transplant survival with induction therapy, regardless of their peak CPRA. TCDA confers decreased number of acute rejection episodes at 1 year in this patient population. |
| format | Article |
| id | doaj-art-a6ef76f00b804567be1568770a42bd5b |
| institution | OA Journals |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
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| series | JHLT Open |
| spelling | doaj-art-a6ef76f00b804567be1568770a42bd5b2025-08-20T02:16:13ZengElsevierJHLT Open2950-13342025-05-01810024610.1016/j.jhlto.2025.100246Induction therapy confers survival advantage in mechanically supported patients regardless of peak CPRA in heart transplantationNataliya Bahatyrevich, MD, MS0Reid Dale, PhD1Matthew Leipzig, BSc2Katharine Casselman Pines, MPH3Shirin Jimenez, MD4Maria Currie, MD, PhD5Department of Surgery, University of California, Davis, Sacramento, CaliforniaDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CaliforniaDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CaliforniaDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CaliforniaDivision of Cardiovascular Medicine, University of California, Davis, Sacramento, CaliforniaDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California; Corresponding author: Maria Currie, MD, PhD, Center for Academic Medicine, 453 Quarry Road, Room 267, MC 5661, Stanford, CA 94304.Background: There is no consensus regarding induction therapy in patients on mechanically circulatory support (MCS) listed for heart transplantation. We sought to elucidate differences in outcomes between no induction and induction. Methods: A total of 3,987 patients were analyzed from the UNOS database from January 2018 through December 2022. Patients on Extracorporeal Membrane Oxygenation (ECMO), HeartMate 3, Impella 5.0 or 5.5, and intra-aortic balloon pump (IABP) and receiving no induction, anti-IL2R antibodies, or T cell depleting agent (TCDA) were included. Results: Of 3,987 patients, 1,288 (32.3%) received no induction, 1,566 (39.3%) received anti-IL2R antibodies, and 1,133 (28.4%) received TCDA. A total of 1,895 (47.5%) were supported with IABP; 1,098 (27.5%) with HeartMate 3; 489 (12.3%) with Impella 5.0 or 5.5; 351 (8.8%) with ECMO; and 154 (3.9%) with combination of the above devices. Comparison of 1-year survival between no induction, anti-IL2R, and TCDA groups in all MCS patients revealed significantly worse survival among those receiving no induction (p<0.0001). Subgroup analysis of peak CPRA 0% patients revealed that no induction had significantly worse survival at 1 year (p=0.002). Analysis of acute rejection at 1 year showed a significantly decreased number of rejection episodes in the TCDA group compared to no induction (OR 0.65, CI 0.47-0.88, p=0.006). Conclusions: Patients requiring MCS prior to heart transplantation have significantly improved post-transplant survival with induction therapy, regardless of their peak CPRA. TCDA confers decreased number of acute rejection episodes at 1 year in this patient population.http://www.sciencedirect.com/science/article/pii/S2950133425000412immunosuppressioninduction therapyT-cell depleting agentsinterleukin-2 receptor antagonistsmechanical circulatory supportheart transplantation |
| spellingShingle | Nataliya Bahatyrevich, MD, MS Reid Dale, PhD Matthew Leipzig, BSc Katharine Casselman Pines, MPH Shirin Jimenez, MD Maria Currie, MD, PhD Induction therapy confers survival advantage in mechanically supported patients regardless of peak CPRA in heart transplantation JHLT Open immunosuppression induction therapy T-cell depleting agents interleukin-2 receptor antagonists mechanical circulatory support heart transplantation |
| title | Induction therapy confers survival advantage in mechanically supported patients regardless of peak CPRA in heart transplantation |
| title_full | Induction therapy confers survival advantage in mechanically supported patients regardless of peak CPRA in heart transplantation |
| title_fullStr | Induction therapy confers survival advantage in mechanically supported patients regardless of peak CPRA in heart transplantation |
| title_full_unstemmed | Induction therapy confers survival advantage in mechanically supported patients regardless of peak CPRA in heart transplantation |
| title_short | Induction therapy confers survival advantage in mechanically supported patients regardless of peak CPRA in heart transplantation |
| title_sort | induction therapy confers survival advantage in mechanically supported patients regardless of peak cpra in heart transplantation |
| topic | immunosuppression induction therapy T-cell depleting agents interleukin-2 receptor antagonists mechanical circulatory support heart transplantation |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425000412 |
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