Induction regimen and survival in simultaneous heart-kidney transplant recipients. Academic Article uri icon


  • 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- (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- 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.

published proceedings

  • J Heart Lung Transplant

author list (cited authors)

  • Ariyamuthu, V. K., Amin, A. A., Drazner, M. H., Araj, F., Mammen, P., Ayvaci, M., ... Tanriover, B.

citation count

  • 8

complete list of authors

  • Ariyamuthu, Venkatesh K||Amin, Alpesh A||Drazner, Mark H||Araj, Faris||Mammen, Pradeep PA||Ayvaci, Mehmet||Mete, Mutlu||Ozay, Fatih||Ghanta, Mythili||Mohan, Sumit||Mohan, Prince||Tanriover, Bekir

publication date

  • May 2018