Key result
Induction with IL-2RB in heart transplant recipients decreased rejection hazard compared with ATG and no induction (p<0.01), but increased 4-week infection risk (5.0 vs 1.8 vs 1.6; p<0.01).
Why the study?
Does induction therapy with IL-2RB or ATG reduce rejection or increase infection risk in primary heart transplant patients compared to no induction?
Cohort (n=2,090)
Yes
Does induction therapy with IL-2RB or ATG reduce rejection or increase infection risk in primary heart transplant patients compared to no induction?
Absolute Event Rate: 5% vs 1.6%
p-value: p=<0.01
IL-2RB induction reduces rejection risk but increases infection risk in heart transplant patients, particularly those at high baseline risk for infection.
May warrant caution with IL-2RB due to infection risk; leaves open optimal induction strategy pending randomized trials.
Data from Cardiac Transplant Research Database (CTRD) were analyzed from 1999 to 2006 to examine the effects of different induction strategies at the time of cardiac transplantation. A total of 2090 primary heart transplants were categorized by induction with interleukin-2 receptor blocker (IL-2RB), antithymocyte globulin (ATG), or no induction (NI). Probabilities for rejection and infection were estimated with parametric time-related models. Using these models, hazard was calculated for two theoretical patient profiles, one at lower risk for rejection and higher risk of infection (Profile 1) and higher risk for rejection and lower risk of infection (Profile 2). Of the 2090 transplants, 49.8% (1095) did not receive induction, 27.3% (599) received IL-2RB, and 18.0% (396) received ATG. Profile 1 patients had lower hazard for rejection with IL-2RB compared to ATG and NI (p < 0.01), but at the cost of increased risk of infection (5.0 vs. 1.8 vs. 1.6, respectively, at four wk, p < 0.01). Profile 2 patients experienced a fivefold decreased hazard for rejection when treated with IL-2RB compared with ATG and NI (p < 0.01). In patients at high risk of infection, IL-2RB reduced risk of rejection but at the expense of increased hazard for infection.
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Mazimba et al. (2014) conducted a cohort in Primary heart transplantation (n=2,090). Interleukin-2 receptor blocker (IL-2RB) or antithymocyte globulin (ATG) vs. No induction (NI) was evaluated on Infection at four weeks (Profile 1) (p=<0.01). Induction with IL-2RB in heart transplant recipients decreased rejection hazard compared with ATG and no induction (p<0.01), but increased 4-week infection risk (5.0 vs 1.8 vs 1.6; p<0.01).
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