Induction therapy confers survival advantage in mechanically supported patients regardless of peak CPRA in heart transplantation

JHLT Open Pub Date : 2025-03-31 DOI:10.1016/j.jhlto.2025.100246

Nataliya Bahatyrevich MD, MS , Reid Dale PhD , Matthew Leipzig BSc , Katharine Casselman Pines MPH , Shirin Jimenez MD , Maria Currie MD, PhD

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Abstract

Background

There is no consensus regarding induction therapy in patients on mechanically circulatory support (MCS) listed for heart transplantation. We sought to elucidate differences in outcomes between no induction and induction.

Methods

A total of 3,987 patients were analyzed from the UNOS database from January 2018 through December 2022. Patients on Extracorporeal Membrane Oxygenation (ECMO), HeartMate 3, Impella 5.0 or 5.5, and intra-aortic balloon pump (IABP) and receiving no induction, anti-IL2R antibodies, or T cell depleting agent (TCDA) were included.

Results

Of 3,987 patients, 1,288 (32.3%) received no induction, 1,566 (39.3%) received anti-IL2R antibodies, and 1,133 (28.4%) received TCDA. A total of 1,895 (47.5%) were supported with IABP; 1,098 (27.5%) with HeartMate 3; 489 (12.3%) with Impella 5.0 or 5.5; 351 (8.8%) with ECMO; and 154 (3.9%) with combination of the above devices. Comparison of 1-year survival between no induction, anti-IL2R, and TCDA groups in all MCS patients revealed significantly worse survival among those receiving no induction (p<0.0001). Subgroup analysis of peak CPRA 0% patients revealed that no induction had significantly worse survival at 1 year (p=0.002). Analysis of acute rejection at 1 year showed a significantly decreased number of rejection episodes in the TCDA group compared to no induction (OR 0.65, CI 0.47-0.88, p=0.006).

Conclusions

Patients requiring MCS prior to heart transplantation have significantly improved post-transplant survival with induction therapy, regardless of their peak CPRA. TCDA confers decreased number of acute rejection episodes at 1 year in this patient population.

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诱导疗法赋予机械支持的患者生存优势，无论心脏移植中CPRA峰值如何

背景：对于心脏移植中机械循环支持（MCS）患者的诱导治疗，目前还没有达成共识。我们试图阐明无诱导和诱导之间结果的差异。方法对2018年1月至2022年12月UNOS数据库中的3987例患者进行分析。纳入接受体外膜氧合（ECMO）、HeartMate 3、Impella 5.0或5.5、主动脉内球囊泵（IABP）治疗且未接受诱导、抗il2r抗体或T细胞消耗剂（TCDA）治疗的患者。结果3987例患者中，未诱导1288例（32.3%），抗il2r抗体1566例（39.3%），TCDA 1133例（28.4%）。共有1895份（47.5%）得到IABP的支持；使用HeartMate 3的1098人（27.5%）；489（12.3%）使用Impella 5.0或5.5；ECMO 351例（8.8%）；联合使用的154例（3.9%）。在所有MCS患者中，未诱导组、抗il2r组和TCDA组的1年生存率比较显示，未诱导组的生存率明显较差（p<0.0001）。峰值CPRA 0%患者的亚组分析显示，未诱导患者的1年生存率明显较差（p=0.002）。1年急性排斥反应分析显示，与未诱导相比，TCDA组排斥反应发生率显著降低（OR 0.65, CI 0.47-0.88, p=0.006）。结论：在心脏移植前需要MCS的患者，无论其CPRA峰值如何，诱导治疗均可显著提高移植后生存率。在该患者群体中，TCDA可减少1年急性排斥事件的发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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JHLT Open

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