Allograft vasculopathy
Delayed Onset of Cardiac Allograft Vasculopathy by Induction Therapy Using Anti-thymocyte Globulin

https://doi.org/10.1016/j.healun.2008.02.016Get rights and content

Background

In this study we sought to compare the long-term effects of anti-thymocyte globulin (ATG) and muromonab-CD3 (OKT3) as induction therapy after heart transplantation, with special regard to cardiac allograft vasculopathy (CAV), post-transplant infections, post-transplant non-skin cancers and patient survival.

Methods

From 1988 to 1991, 25 heart transplant patients received OKT3 as induction treatment. Accordingly, 25 consecutive patients who received ATG and 25 consecutive patients without induction therapy were enrolled.

Results

At a follow-up period of 13.4 ± 4.6 years, time to onset of non-significant and significant CAV was 8.77 ± 3.38 and 11.60 ± 4.28 years, respectively, in the ATG group, which was significantly delayed compared with 5.71 ± 3.08 and 7.44 ± 2.74 years, respectively, in the non-induction group. In the OKT3 group, time to onset of non-significant and significant CAV (6.10 ± 2.73 and 7.86 ± 3.19 years, respectively) did not differ significantly from the non-induction group. Ten- and 15-year actuarial survival rates of ATG- and OKT3-treated patients were not significantly different from those of patients without induction treatment.

Conclusions

Our study suggests the long-term advantage of ATG in prevention of cardiac allograft vasculopathy. In contrast, OKT3 failed to show such benefit. However, induction therapy with either ATG or OKT3 did not exhibit a significant beneficial effect on long-term patient survival.

Section snippets

Study Population

From January 1988 to September 1991, 194 orthotopic HTxs were performed at our institution. Among them, 134 patients were ≥18 years of age and receiving their first orthotopic HTx and surviving >3 years without re-do HTx. From this sub-population, a total of 25 patients received muromonab-CD3 (OKT3; Janssen-Cilag, The Netherlands) 0.1 to 0.2 mg/kg/day, with a maximum dose of 5 mg/day for seven doses as induction treatment, and participated in this study as the OKT3 group. Accordingly, we

Results

A total of 75 HTx recipients (56 men, 19 women; mean age 59.3 ± 12.1 years) were evaluated at a mean follow-up period of 13.4 ± 4.6 years. The length of the follow-up period did not differ significantly between the three study groups (14.0 ± 5.0 years in the ATG group, 12.6 ± 5.1 years in the OKT3 group, 13.6 ± 3.6 years in the non-induction group; between-group p = 0.520).

Discussion

The results of the present study confirm that both ATG and OKT3 as induction treatment are effective in reducing the occurrence of acute rejection episodes after cardiac transplantation. Similar findings were also reported in other comparative studies.14, 16, 17 However, no definitive superiority between ATG and OKT3 with regard to reducing acute rejection could be observed in the present study. In one of the first comparisons between induction therapy with ATG and OKT3, Starnes et al found

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