PURPOSE: The most commonly used induction agents in lung transplant are the IL-2 receptor antagonists (ISHLT 2008 Database). These agents are associated with decreased frequency and severity of acute rejection. At our instituition, we currently use the IL-2 receptor antagonist, basiliximab. Manufacturer’ s recommendations are 20mg within 2 hours prior to implantation and 20mg on postoperative day 4. From January 2000 to March 2006, the initial dose was given after implantation and prior to January 2000, we did not use lymphocyte inhibition induction. We hypothesized that the timing of administration would impact the frequency and severity of acute rejection in the first year, and may impact the development of Bronchiolitis Obliterans Syndrome (BOS).
METHODS: We reviewed records of the 122 patients who underwent lung transplant at Henry Ford Hospital from October 1994 to January 2009. Excluded from the analysis were patients with survival less than one year. 30 patients did not receive basiliximab (no induction), 37 patients received the first dose of basiliximab after implantation (post-implant basiliximab), and 22 patients received the first dose prior to implantation (pre-implant basiliximab). The primary outcome was cumulative acute rejection score (CAR) in the first postoperative year. Secondary outcomes were freedom from BOS and frequency of invasive CMV or aspergillus infection.
RESULTS: The CAR score for pre-implant basiliximab was 2.45. This was significantly lower than CAR score of 4.65 in the post-implant group (p=0.02) and 6.33 in no induction group (p=0.0001) There was no difference in freedom from BOS or invasive infections between pre and post-implant group.
CONCLUSION: It is hypothesized that lymphocyte inhibition prior to implantation may contribute to development of allograft tolerance. Our data shows an association between pre-implant basiliximab and lower CAR score compared with both post-implant basiliximab and no induction. Despite lower CAR score, there was not a significant difference in freedom from BOS.
CLINICAL IMPLICATIONS: Further investigation is warranted to determine if other induction protocols can lead to lower CAR score and greater freedom from BOS.
DISCLOSURE: Rajeev Swarup, No Financial Disclosure Information; No Product/Research Disclosure Information