The impact of induction on survival after lung transplantation: an analysis of the International Society for Heart and Lung Transplantation Registry

Clin Transplant. 2008 Sep-Oct;22(5):603-8. doi: 10.1111/j.1399-0012.2008.00831.x. Epub 2008 Apr 23.


Background: The use of induction immunosuppression after lung transplantation remains controversial. In this study, we examined the impact of induction on survival after lung transplantation.

Methods: We performed a retrospective cohort study of 3970 adult lung transplant recipients reported to the ISHLT Registry. We divided the cohort into three groups based on the use of induction: none, interleukin-2 receptor antagonists (IL-2 RA), and polyclonal antithymocyte globulins (ATG). We estimated graft survival using the Kaplan-Meier method and constructed a multivariable Cox proportional hazards model to examine the impact of induction on graft survival in the context of other variables.

Results: During the study period, 2249 patients received no induction, 1124 received IL-2 RA, and 597 received ATG. Four years after transplantation, recipients treated with IL-2 RA had better graft survival (64%) than those treated with ATG (60%) and those who did not receive induction (57%; log rank p = 0.0067). This survival advantage persisted in the multivariable model for single and bilateral recipients treated with IL-2 RA compared to those who did not receive induction (RR = 0.82, p = 0.007). Similarly, bilateral recipients treated with ATG had a survival advantage over bilateral recipients who did not receive induction (RR = 0.78, p = 0.043), but single lung recipients treated with ATG did not have a survival advantage over single lung recipients who did not receive induction (RR = 1.06, p = 0.58).

Conclusions: Induction with lL-2 RA for single and bilateral lung recipients and induction with ATG for bilateral recipients are associated with a survival benefit, independent of other variables that might impact survival.

MeSH terms

  • Antilymphocyte Serum / adverse effects*
  • Bronchiolitis Obliterans / etiology
  • Bronchiolitis Obliterans / prevention & control
  • Female
  • Follow-Up Studies
  • Graft Rejection / prevention & control*
  • Graft Survival / immunology
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Lung Transplantation / adverse effects
  • Lung Transplantation / immunology*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Receptors, Interleukin-2 / antagonists & inhibitors*
  • Registries*
  • Retrospective Studies
  • Risk
  • Survival Analysis


  • Antilymphocyte Serum
  • Immunosuppressive Agents
  • Receptors, Interleukin-2