Gorav Ailawadi, Philip W. Smith, Tomomi Oka, Wang Hongkun, K Robert Shen, Benjamin D. Kozower, Thomas M. Daniel, Irving L. Kron, David R. Jones; TCV Surgery, University of Virginia, Charlottesville, VA
Objective: The effects of daclizumab (Zenapex) and anti-thymocyte globulin (ATGAM) induction following lung transplantation on acute rejection (AR), bronchiolitis obliterans syndrome (BOS), and survival are unknown. We hypothesize that daclizumab induction results in lower incidence of AR, BOS, and improved survival.Methods: Consecutive adult lung transplants (N=163) performed at our institution from January 1998 to May 2006 were entered prospectively into our transplant registry including preoperative, intraoperative, and follow-up data. ATGAM induction was performed prior to January 2002 (65 patients, 30 male/ 35 female, median follow-up 4.6 years) after which all patients received daclizumab induction (98 patients, 55 male/ 43 female, median follow-up 1.8 years). AR, BOS, and survival were compared using Kaplan-Meier analyses to account for time to event and compared by logrank test. At 2-year follow-up, incidence of AR, BOS, and survival were compared using Chi Square analysis. Cox proportional hazards models were fit to adjust for covariates including donor and recipient age, CMV mismatch, diagnosis, and induction regimen.
Results: The two groups were no different with respect to demographics or preoperative and intraoperative risk factors. Using Kaplan-Meier method, daclizumab patients had significantly less AR (p=0.002), less BOS (p=.016) and improved overall survival (p=0.04). At 2-year follow-up, the daclizumab group had less AR (9% (9/98) vs 28% (18/65), P=.002), BOS (6.4% (6/96) vs 23% (14/60), P=.002), and improved survival (94% (92/98) vs 83% (54/65), P=.03) compared to ATGAM. Adjusting for covariates, only induction remained a significant predictor for AR (p=.022), BOS (p=.05), and approached significance for survival (p=.07).
Conclusion: Compared to ATGAM, lung transplant recipients receiving daclizumab induction experience significantly less acute rejection and bronchiolitis obliterans, and have an improved overall survival.
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