Impact of induction therapy on cytomegalovirus infection and post‐transplant outcomes in pediatric heart transplant recipients receiving routine antiviral prophylaxis

• Published in: Clinical transplantation Vol. 37; no. 1; pp. e14836 - n/a
• Main Authors: Zang, Suhua, Zhang, Xin, Niu, Jianli, Das, Bibhuti B.
• Format: Journal Article
• Language: English
• Published: Denmark 01.01.2023
• Subjects: Adolescent; Antilymphocyte Serum - therapeutic use; Antiviral Agents - therapeutic use; antiviral prophylaxis; ATG; basiliximab; Basiliximab - therapeutic use; Child; cytomegalovirus; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - etiology; Cytomegalovirus Infections - prevention & control; Graft Rejection - drug therapy; Graft Rejection - epidemiology; Graft Rejection - etiology; Heart Transplantation - adverse effects; Humans; Immunosuppressive Agents - therapeutic use; Induction Chemotherapy; pediatric heart transplantation; Retrospective Studies; Transplant Recipients; basiliximab; antiviral prophylaxis; ATG; cytomegalovirus; pediatric heart transplantation
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.14836

Objectives Induction therapy has been increasingly used in pediatric heart transplantation. This study evaluated the impact of anti‐thymocyte globulin (ATG) versus basiliximab as induction therapy on post‐transplant cytomegalovirus (CMV) infection, rejection at 1 year, coronary allograft vasculopathy (CAV), and mortality in pediatric heart transplant recipients receiving antiviral prophylaxis. Results Of the 96 patients (age < 18 years) analyzed, 46 (47.9%) patients received basiliximab, and 50 (52.1%) received ATG. Median follow‐up was 3.0 (IQR, 1.7–4.9) years with 32.3% reporting CMV infection. The ATG group, as compared with the basiliximab group, had similar incidences of CMV infection (36% vs. 28.3%, p = .418), CMV viremia (22% vs. 19.6%, p = .769), and CMV‐positive tissue biopsy (30% vs. 22%, p = .486). The ATG group had lower incidences of rejection at 1 year (16% vs. 36.9%, p = .022) and CAV (4% vs. 23.9%, p = .006) with no difference in mortality (8% vs. 15.2%, p = .343), compared with the basiliximab group. Multivariate analysis showed that induction with ATG was associated with a lower risk of rejection at 1 year (OR, .31; 95% CI, .09–.94; p = .039) with no impact on the incidences of CMV infection (HR, 2.06; 95% CI, .54–7.89; p = .292), CAV (HR, .30; 95% CI, .04–2.58; p = .275), and mortality (HR, .39; 95% CI, .09–1.82; p = .233) compared to basiliximab induction. Discussion and conclusions In conclusion, induction with ATG was associated with reduction in risk of rejection at 1 year with no effects on CMV infection, CAV, and mortality in pediatric heart transplant recipients with universal antiviral prophylaxis compared with basiliximab induction therapy.