Risk stratification to determine the impact of induction therapy on survival, rejection, and adverse events after Pediatric Heart Transplant: A multi-institutional study

Background Induction therapy is increasingly used in pediatric heart transplant. General vs. risk-adapted use remains controversial. We aimed to determine the impact of induction therapy on outcomes after stratifying patients by diagnosis and risk. Methods The Pediatric Heart Transplant Study (PHTS) database was used to identify patients (age ≤18 years) who underwent transplantation between January 1, 2001, and December 31, 2014. Patients were excluded if they survived Results Of 2,860 patients, 1,370 received anti-lymphocyte antibody (ALA), 707 received an interleukin-2 receptor antagonist (IL2RA), and 783 received no induction (NI) therapy. Overall, patients with NI had lower survival (p Conclusion Pediatric heart transplant survival has improved in the recent era, in concert with increased use of induction therapy. Although induction therapy is associated with decreased rejection, it was not found to directly influence survival on multivariable analysis. Lower risk patients may benefit the most from induction therapy, particularly with IL2RA, which may be correlated with decreased infection and rejection in this cohort.