Butts Ryan, Davis Melanie, Savage Andrew, Burnette Ali, Kavarana Minoo, Bradley Scott, Atz Andrew, Nietert Paul J
1 Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC. 2 Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC. 3 Department of Transplant Services, Medical University of South Carolina, Charleston, SC. 4 Department of Surgery, Medical University of South Carolina, Charleston, SC.
Transplantation. 2017 Jun;101(6):1228-1233. doi: 10.1097/TP.0000000000001285.
The use of induction therapy in pediatric heart transplantation has increased. The aim of this study was to investigate the effects of induction therapy on graft survival.
The United Network for Organ Sharing database was queried for isolated pediatric heart transplants from January 1, 1994, to December 31, 2013. Propensity scores for induction treatment were calculated by estimating probability of induction using a logistic regression model. Transplants were then matched between induction treatment groups based on the propensity score, reducing potential biases. Using only propensity score matched transplants, the effect of induction therapy on graft survival was investigated using Cox-proportional hazards. Subgroup analyses were performed based on age, race, recipient cardiac diagnosis, HLA, and recipient panel-reactive antibody (PRA).
Of 4565 pediatric primary heart transplants from 1994 to 2013, 3741 had complete data for the propensity score calculation. There were 2792 transplants successfully matched (induction, n = 1396; no induction, n = 1396). There were no significant differences in transplant and pretransplant covariates between induction and no induction groups. In the Cox-proportional hazards model, the use of induction of was not associated with graft loss (hazard ratio [HR], 0.88; 95% confidence interval [95% CI], 0.75-1.01; P = 0.07). In subgroup analyses, induction therapy may be associated with improved survival in patients with PRA greater than 50% (HR, 0.57; 95% CI, 0.34-0.97) and congenital heart disease (HR, 0.78; 95% CI, 0.64-0.96).
Induction therapy is not associated with improved graft survival in primary pediatric heart transplantation. However, in pediatric heart transplant recipients with PRA greater than 50% or congenital heart disease, induction therapy is associated with improved survival.
小儿心脏移植中诱导治疗的应用有所增加。本研究的目的是调查诱导治疗对移植物存活的影响。
查询器官共享联合网络数据库，获取1994年1月1日至2013年12月31日期间孤立的小儿心脏移植数据。通过使用逻辑回归模型估计诱导治疗的概率来计算诱导治疗的倾向评分。然后根据倾向评分在诱导治疗组之间进行移植匹配，以减少潜在偏倚。仅使用倾向评分匹配的移植，采用Cox比例风险模型研究诱导治疗对移植物存活的影响。根据年龄、种族、受者心脏诊断、人类白细胞抗原（HLA）和受者群体反应性抗体（PRA）进行亚组分析。
在1994年至2013年的4565例小儿初次心脏移植中，3741例有完整数据用于倾向评分计算。有2792例移植成功匹配（诱导治疗组，n = 1396；未诱导治疗组，n = 1396）。诱导治疗组和未诱导治疗组在移植及移植前协变量方面无显著差异。在Cox比例风险模型中，使用诱导治疗与移植物丢失无关（风险比[HR]，0.88；95%置信区间[95%CI]，0.75 - 1.01；P = 0.07）。在亚组分析中，诱导治疗可能与PRA大于50%的患者（HR，0.57；95%CI，0.34 - 0.97）和先天性心脏病患者（HR，0.78；95%CI，0.64 - 0.96）的存活率提高有关。
在小儿初次心脏移植中，诱导治疗与移植物存活率提高无关。然而，在PRA大于50%或患有先天性心脏病的小儿心脏移植受者中，诱导治疗与存活率提高有关。
