Effects of induction immunosuppression regimen on acute rejection, bronchiolitis obliterans, and survival after lung transplantation

Gorav Ailawadi, Philip W. Smith, Tomomi Oka, Hongkun Wang, Benjamin D. Kozower, Thomas M. Daniel, Irving L. Kron, David R. Jones

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective: Effects of daclizumab and antithymocyte globulin induction on acute rejection, bronchiolitis obliterans syndrome, and survival after lung transplantation are unknown. We hypothesized that daclizumab results in less acute rejection and bronchiolitis obliterans and better survival than antithymocyte globulin. Methods: Consecutive adult lung transplants (n = 163) at the University of Virginia from January 1998 to May 2006 were reviewed. Antithymocyte globulin induction was routinely performed before January 2002 (65 patients), after which all patients received daclizumab (98 patients). Estimates of cumulative event rate of acute rejection, bronchiolitis obliterans, and death were calculated by Kaplan-Meier method and between-group differences compared by log-rank test. Cox proportional hazards models were fitted to assess treatment effects adjusted for covariates. Results: Groups were similar in demographics and preoperative and intraoperative risk factors. Maintenance immunosuppression changed during the study, and mycophenolate mofetil was more commonly given to patients receiving daclizumab. By Kaplan-Meier method, daclizumab was associated with significantly less acute rejection (P = .002), less bronchiolitis obliterans (P = .02), and improved overall survival (P = .04). Induction agent was highly associated with acute rejection (P = .002), bronchiolitis obliterans (P = .02), and mortality (P = .05); antimetabolite agent was associated only with acute rejection (P = .01). Adjusting for covariates, induction agent remained significantly predictive for acute rejection (P = .02) and bronchiolitis obliterans (P = .05), approaching significance for survival (P = .07). Conclusion: Lung transplant recipients receiving daclizumab for induction had significantly less acute rejection and bronchiolitis obliterans than those receiving antithymocyte globulin, with possibly improved survival. Improvements in acute rejection may have been confounded by the use of mycophenolate mofetil.

Original languageEnglish (US)
Pages (from-to)594-602
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume135
Issue number3
DOIs
StatePublished - Mar 1 2008
Externally publishedYes

Fingerprint

Bronchiolitis Obliterans
Lung Transplantation
Immunosuppression
Antilymphocyte Serum
Survival
Mycophenolic Acid
Antimetabolites
Lung
Proportional Hazards Models
daclizumab
Maintenance
Demography
Transplants
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Effects of induction immunosuppression regimen on acute rejection, bronchiolitis obliterans, and survival after lung transplantation. / Ailawadi, Gorav; Smith, Philip W.; Oka, Tomomi; Wang, Hongkun; Kozower, Benjamin D.; Daniel, Thomas M.; Kron, Irving L.; Jones, David R.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 135, No. 3, 01.03.2008, p. 594-602.

Research output: Contribution to journalArticle

Ailawadi, Gorav ; Smith, Philip W. ; Oka, Tomomi ; Wang, Hongkun ; Kozower, Benjamin D. ; Daniel, Thomas M. ; Kron, Irving L. ; Jones, David R. / Effects of induction immunosuppression regimen on acute rejection, bronchiolitis obliterans, and survival after lung transplantation. In: Journal of Thoracic and Cardiovascular Surgery. 2008 ; Vol. 135, No. 3. pp. 594-602.
@article{f583fbbe9b884c1a9784158b33a96782,
title = "Effects of induction immunosuppression regimen on acute rejection, bronchiolitis obliterans, and survival after lung transplantation",
abstract = "Objective: Effects of daclizumab and antithymocyte globulin induction on acute rejection, bronchiolitis obliterans syndrome, and survival after lung transplantation are unknown. We hypothesized that daclizumab results in less acute rejection and bronchiolitis obliterans and better survival than antithymocyte globulin. Methods: Consecutive adult lung transplants (n = 163) at the University of Virginia from January 1998 to May 2006 were reviewed. Antithymocyte globulin induction was routinely performed before January 2002 (65 patients), after which all patients received daclizumab (98 patients). Estimates of cumulative event rate of acute rejection, bronchiolitis obliterans, and death were calculated by Kaplan-Meier method and between-group differences compared by log-rank test. Cox proportional hazards models were fitted to assess treatment effects adjusted for covariates. Results: Groups were similar in demographics and preoperative and intraoperative risk factors. Maintenance immunosuppression changed during the study, and mycophenolate mofetil was more commonly given to patients receiving daclizumab. By Kaplan-Meier method, daclizumab was associated with significantly less acute rejection (P = .002), less bronchiolitis obliterans (P = .02), and improved overall survival (P = .04). Induction agent was highly associated with acute rejection (P = .002), bronchiolitis obliterans (P = .02), and mortality (P = .05); antimetabolite agent was associated only with acute rejection (P = .01). Adjusting for covariates, induction agent remained significantly predictive for acute rejection (P = .02) and bronchiolitis obliterans (P = .05), approaching significance for survival (P = .07). Conclusion: Lung transplant recipients receiving daclizumab for induction had significantly less acute rejection and bronchiolitis obliterans than those receiving antithymocyte globulin, with possibly improved survival. Improvements in acute rejection may have been confounded by the use of mycophenolate mofetil.",
author = "Gorav Ailawadi and Smith, {Philip W.} and Tomomi Oka and Hongkun Wang and Kozower, {Benjamin D.} and Daniel, {Thomas M.} and Kron, {Irving L.} and Jones, {David R.}",
year = "2008",
month = "3",
day = "1",
doi = "10.1016/j.jtcvs.2007.10.044",
language = "English (US)",
volume = "135",
pages = "594--602",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Effects of induction immunosuppression regimen on acute rejection, bronchiolitis obliterans, and survival after lung transplantation

AU - Ailawadi, Gorav

AU - Smith, Philip W.

AU - Oka, Tomomi

AU - Wang, Hongkun

AU - Kozower, Benjamin D.

AU - Daniel, Thomas M.

AU - Kron, Irving L.

AU - Jones, David R.

PY - 2008/3/1

Y1 - 2008/3/1

N2 - Objective: Effects of daclizumab and antithymocyte globulin induction on acute rejection, bronchiolitis obliterans syndrome, and survival after lung transplantation are unknown. We hypothesized that daclizumab results in less acute rejection and bronchiolitis obliterans and better survival than antithymocyte globulin. Methods: Consecutive adult lung transplants (n = 163) at the University of Virginia from January 1998 to May 2006 were reviewed. Antithymocyte globulin induction was routinely performed before January 2002 (65 patients), after which all patients received daclizumab (98 patients). Estimates of cumulative event rate of acute rejection, bronchiolitis obliterans, and death were calculated by Kaplan-Meier method and between-group differences compared by log-rank test. Cox proportional hazards models were fitted to assess treatment effects adjusted for covariates. Results: Groups were similar in demographics and preoperative and intraoperative risk factors. Maintenance immunosuppression changed during the study, and mycophenolate mofetil was more commonly given to patients receiving daclizumab. By Kaplan-Meier method, daclizumab was associated with significantly less acute rejection (P = .002), less bronchiolitis obliterans (P = .02), and improved overall survival (P = .04). Induction agent was highly associated with acute rejection (P = .002), bronchiolitis obliterans (P = .02), and mortality (P = .05); antimetabolite agent was associated only with acute rejection (P = .01). Adjusting for covariates, induction agent remained significantly predictive for acute rejection (P = .02) and bronchiolitis obliterans (P = .05), approaching significance for survival (P = .07). Conclusion: Lung transplant recipients receiving daclizumab for induction had significantly less acute rejection and bronchiolitis obliterans than those receiving antithymocyte globulin, with possibly improved survival. Improvements in acute rejection may have been confounded by the use of mycophenolate mofetil.

AB - Objective: Effects of daclizumab and antithymocyte globulin induction on acute rejection, bronchiolitis obliterans syndrome, and survival after lung transplantation are unknown. We hypothesized that daclizumab results in less acute rejection and bronchiolitis obliterans and better survival than antithymocyte globulin. Methods: Consecutive adult lung transplants (n = 163) at the University of Virginia from January 1998 to May 2006 were reviewed. Antithymocyte globulin induction was routinely performed before January 2002 (65 patients), after which all patients received daclizumab (98 patients). Estimates of cumulative event rate of acute rejection, bronchiolitis obliterans, and death were calculated by Kaplan-Meier method and between-group differences compared by log-rank test. Cox proportional hazards models were fitted to assess treatment effects adjusted for covariates. Results: Groups were similar in demographics and preoperative and intraoperative risk factors. Maintenance immunosuppression changed during the study, and mycophenolate mofetil was more commonly given to patients receiving daclizumab. By Kaplan-Meier method, daclizumab was associated with significantly less acute rejection (P = .002), less bronchiolitis obliterans (P = .02), and improved overall survival (P = .04). Induction agent was highly associated with acute rejection (P = .002), bronchiolitis obliterans (P = .02), and mortality (P = .05); antimetabolite agent was associated only with acute rejection (P = .01). Adjusting for covariates, induction agent remained significantly predictive for acute rejection (P = .02) and bronchiolitis obliterans (P = .05), approaching significance for survival (P = .07). Conclusion: Lung transplant recipients receiving daclizumab for induction had significantly less acute rejection and bronchiolitis obliterans than those receiving antithymocyte globulin, with possibly improved survival. Improvements in acute rejection may have been confounded by the use of mycophenolate mofetil.

UR - http://www.scopus.com/inward/record.url?scp=40149104213&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=40149104213&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2007.10.044

DO - 10.1016/j.jtcvs.2007.10.044

M3 - Article

C2 - 18329476

AN - SCOPUS:40149104213

VL - 135

SP - 594

EP - 602

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 3

ER -