Venkatesh K Ariyamuthu1, Alpesh A Amin2, Mark H Drazner2, Faris Araj2, Pradeep P A Mammen2, Mehmet Ayvaci3, Mutlu Mete4, Fatih Ozay5, Mythili Ghanta5, Sumit Mohan6, Prince Mohan7, Bekir Tanriover5. 1. Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: venkateshkumar.ariyamuthu@utsouthwestern.edu. 2. Division of, Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas. 3. Information Systems, School of Management, University of Texas at Dallas, Dallas, Texas. 4. Department of Computer Science, Texas A&M University-Commerce, Commerce, Texas. 5. Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas. 6. Division of Nephrology, Columbia University Medical Center, New York, New York. 7. Division of Nephrology, Geisinger Medical Center, Danville, Pennnsylvania.
Abstract
BACKGROUND: Induction therapy in simultaneous heart-kidney transplantation (SHKT) is not well studied in the setting of contemporary maintenance immunosuppression consisting of tacrolimus (TAC), mycophenolic acid (MPA), and prednisone (PRED). METHODS: We analyzed the Organ Procurement and Transplant Network registry from January 1, 2000, to March 3, 2015, for recipients of SHKT (N = 623) maintained on TAC/MPA/PRED at hospital discharge. The study cohort was further stratified into 3 groups by induction choice: induction (n = 232), rabbit anti-thymoglobulin (r-ATG; n = 204), and interleukin-2 receptor-α (n = 187) antagonists. Survival rates were estimated using the Kaplan-Meier estimator. Multivariable inverse probability weighted Cox proportional hazard regression models were used to assess hazard ratios associated with post-transplant mortality as the primary outcome. The study cohort was censored on March 4, 2016, to allow at least 1-year of follow-up. RESULTS: During the study period, the number of SHKTs increased nearly 5-fold. The Kaplan-Meier survival curve showed superior outcomes with r-ATG compared with no induction or interleukin-2 receptor-α induction. Compared with the no-induction group, an inverse probability weighted Cox proportional hazard model showed no independent association of induction therapy with the primary outcome. In sub-group analysis, r-ATG appeared to lower mortality in sensitized patients with panel reactive antibody of 10% or higher (hazard ratio, 0.19; 95% confidence interval, 0.05-0.71). CONCLUSION: r-ATG may provide a survival benefit in SHKT, especially in sensitized patients maintained on TAC/MPA/PRED at hospital discharge.
BACKGROUND: Induction therapy in simultaneous heart-kidney transplantation (SHKT) is not well studied in the setting of contemporary maintenance immunosuppression consisting of tacrolimus (TAC), mycophenolic acid (MPA), and prednisone (PRED). METHODS: We analyzed the Organ Procurement and Transplant Network registry from January 1, 2000, to March 3, 2015, for recipients of SHKT (N = 623) maintained on TAC/MPA/PRED at hospital discharge. The study cohort was further stratified into 3 groups by induction choice: induction (n = 232), rabbit anti-thymoglobulin (r-ATG; n = 204), and interleukin-2 receptor-α (n = 187) antagonists. Survival rates were estimated using the Kaplan-Meier estimator. Multivariable inverse probability weighted Cox proportional hazard regression models were used to assess hazard ratios associated with post-transplant mortality as the primary outcome. The study cohort was censored on March 4, 2016, to allow at least 1-year of follow-up. RESULTS: During the study period, the number of SHKTs increased nearly 5-fold. The Kaplan-Meier survival curve showed superior outcomes with r-ATG compared with no induction or interleukin-2 receptor-α induction. Compared with the no-induction group, an inverse probability weighted Cox proportional hazard model showed no independent association of induction therapy with the primary outcome. In sub-group analysis, r-ATG appeared to lower mortality in sensitized patients with panel reactive antibody of 10% or higher (hazard ratio, 0.19; 95% confidence interval, 0.05-0.71). CONCLUSION:r-ATG may provide a survival benefit in SHKT, especially in sensitized patients maintained on TAC/MPA/PRED at hospital discharge.
Authors: Mutlu Mete; Mehmet U S Ayvaci; Venkatesh K Ariyamuthu; Alpesh Amin; Matthias Peltz; Jennifer T Thibodeau; Justin L Grodin; Pradeep P A Mammen; Sonia Garg; Faris Araj; Robert Morlend; Mark H Drazner; Nashila AbdulRahim; Yeongin Kim; Yusuf Salam; Ahmet B Gungor; Bulent Delibasi; Suman K Kotla; Malcolm P MacConmara; Prince Mohan Anand; Gaurav Gupta; Bekir Tanriover Journal: Kidney Int Rep Date: 2022-04-09
Authors: Morcos Atef Awad; Lawrence S C Czer; Dominic Emerson; Stanley Jordan; Michele A De Robertis; James Mirocha; Evan Kransdorf; David H Chang; Jignesh Patel; Michelle Kittleson; Danny Ramzy; Joshua S Chung; J Louis Cohen; Fardad Esmailian; Alfredo Trento; Jon A Kobashigawa Journal: J Am Heart Assoc Date: 2019-02-19 Impact factor: 5.501