Abstract
Contemporary Outcomes of ATG Induction in Pediatric Heart Transplant Recipients
The Journal of heart and lung transplantation, v 45(5), pp 706-707
Apr 2026
Abstract
Purpose: Anti-thymocyte globulin (ATG) induction is frequently used to preserve graft function in pediatric heart transplant (HT) recipients. However, whether ATG induction also carries an increased risk of post-transplant lymphoproliferative disorder (PTLD) remains unclear. The balance between adequate immunosuppression and infection or malignancy risk remains under studied. This study aims to clarify whether ATG induction confers a net clinical benefit or harm in contemporary transplant recipients.
Methods: The United Network for Organ Sharing (UNOS) database was queried for pediatric HT recipients from June 2020 and June 2023 with multi-organ and re-transplant patients excluded. Patients were stratified by ATG induction status with a primary endpoint of Kaplan-Meier 3-year survival. Donor and recipient characteristics alongside perioperative outcomes were assessed. Categorical and continuous variables were compared using Chi-Squared and t-test, respectively. All p-values were two-sided tests with p<.05 indicating significance and analyses are reported as (ATG+%, ATG-%, p-value).
Results: A total of 1,391 recipients were analyzed with 959 receiving ATG induction. ATG patients were older (8 vs 7, p=0.005), but otherwise the cohorts were similar. After transplant, ATG recipients had significantly lower risk for stroke (2% vs 6%, p<0.001) and 72-hour mortality (0% vs 1%, p=0.006). The remaining perioperative variables were non-significant with ATG induced patients having increased PTLD diagnosis (4% vs 3%, p=0.26) and malignancy cause of death (1% vs 0%, p=0.40), but similar rates of graft failure cause of death (2% vs 2%, p=0.40) and 3-year mortality (89% vs 90%, p=0.20).
Conclusion: In contemporary pediatric heart transplantation, ATG induction does not carry a statistically significant increased risk of PTLD diagnosis or death from malignancy. In both cohorts, death from graft failure was larger than malignancy rates, which underscores rejection as the principal limitation to long-term survival.
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Details
- Title
- Contemporary Outcomes of ATG Induction in Pediatric Heart Transplant Recipients
- Creators
- J. White - University of California, Los AngelesH. Zappacosta - University of California, Los AngelesS. McKay - University of California, Los AngelesJ. Song - University of California, Los AngelesP. Cho - Drexel UniversityA. Abramov - University of California, Los AngelesM. Daniel - University of California, Los AngelesD. Telesca - University of California, Los AngelesA. Ardehali - University of California, Los AngelesM. Husain - University of California, Los Angeles
- Publication Details
- The Journal of heart and lung transplantation, v 45(5), pp 706-707
- Conference
- 46th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT), 46th (Toronto, Ontario, Canada, 22 Apr 2026–26 Apr 2026)
- Publisher
- Elsevier Inc
- Number of pages
- 2
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001761683000062
- Other Identifier
- 991022189168004721