The Impact of Alemtuzumab and Basiliximab Induction on Graft and Recipient Survival in Orthotopic Lung Transplantation

Yuka Furuya; Senthil Jayarajan, MS; Sharven Taghavi, MS; Francis Cordova; Namrata Patel; Akira Shiose, PhD; Eros Leotta; Gerard Criner; T. Sloane Guy, MBA; Grayson Wheatley; Larry Kaiser; Yoshiya Toyoda, PhD

PURPOSE: To assess the impact of Alemtuzumab, Basiliximab, and No Induction agents on patient survival, acute and chronic rejection in orthotopic lung transplantation (OLT).

METHODS: The UNOS database was reviewed for all adult OLT from 2006 to 2013. The primary outcome measured was risk-adjusted all-cause mortality. Secondary outcome was median time to brochiolitis obliterans syndrome (BOS) using Kaplan-Meier log-rank test.

RESULTS: 6343 patients underwent OLT, of which 764 (12%) received Alemtuzumab induction, 2890 (45.6%) received Basiliximab induction, and 2690 (42.4%) received no induction. Alemtuzumab recipients were older (54.5; Basiliximab: 51.3; No Induction: 50.0; p<.001), and more likely to be white (88.8%; Basiliximab: 83.1%; No Induction: 84%; p<.001). Alemtuzumab recipients had donors who were less likely to be male (52.1%; Basiliximab: 59.4%; No Induction: 58.6%; p<0.01), and more likely to be white (72.5%; Basiliximab: 60.8%; No Induction: 61.8%; p<.001). The groups were evenly matched in terms of recipient gender and donor age. Alemtuzumab recipients had higher LAS, as compared to Basiliximab and No Induction, (41.8 vs. 38.0 vs. 41.0; p<.001), were less frequently race mismatched (31.4% vs. 43.6% vs. 42.4%; p<.001), and were more likely to require mechanical ventilation as a bridge to transplantation (21.7% vs. 7.1% vs. 7.1%; p<.001). Median survival time was longer for Alemtuzumab and Basiliximab recipients compared to patients that did not receive induction therapy (2301 vs. 2319 vs. 1900 days; p<0.001). The use of Alemtuzumab (HR: 0.79, 95% CI 0.678-0.921, p=0.003) and Basiliximab (HR: 0.83, 95% CI 0.752-0.92, p<0.001) were independently associated with survival on multivariate analysis. Variables associated with mortality included race mismatch, ischemic time, recipient creatinine and the use of ventilator pre-transplantation. Alemtuzumab recipients had longer median time to BOS (2451 vs. 1476 vs. 1461 days; p<.0001).

CONCLUSIONS: While both induction therapies were associated with improved survival, patients that received induction therapy with Alemtuzumab had a longer median time to BOS.

Chest. 2014;146(4_MeetingAbstracts):976A. doi:10.1378/chest.1991870