Author + information
- Matthew Rafiei,
- Michelle Kittleson,
- Jignesh Patel,
- Ashley Osborne,
- David Chang,
- Lawrence Czer,
- Nancy Reinsmoen and
- Jon Kobashigawa
Anti-thymocyte globulin (ATG) has been used as induction therapy in heart transplant. ATG has been postulated to have anti-humoral properties as human thymus (which contains various cell lines including T- and B-cells) is used to stimulate antibody (Ab) production in rabbits. Abs to these cellular lines may provide benefit to prevent the production of circulating antibodies after heart transplant. Thus, we reviewed our non-sensitized patients who received ATG induction vs those who did not for post-transplant denovo Ab production.
Between January 1, 2006 and August 1, 2011, we assessed 126 heart transplant patients who received 3-5 days of ATG induction and compared them to patients who did not. All patients were given tacrolimus, mycophenolate and corticosteroids. Post-transplant Abs are routinely assessed at 1, 3, 6, and 12 months after heart transplant.
There was a trend for less first-year de novo antibody production in the ATG treated group compared to the control group (see table). None of the patients treated with ATG developed biopsy-proven antibody -mediated rejection requiring treatment. Treated cellular rejection rates were comparable in both groups.
ATG induction therapy may reduce the production of de novo antibodies in non-sensitized heart transplant patients and may result in decreased antibody-mediated rejection. A randomized trial in a larger cohort of patients is warranted.
|Endpoints in the 1st-Year||No ATG Group (N = 113)||ATG Group (N = 13)||p-value|
|De novo Antibody Production in the 1st-year, n (%)||33 (29%)||1 (8%)||0.099|
|Any-Treated Antibody-Mediated Rejection, n (%)||7 (6%)||0 (0%)||0.359|
|Any-Treated Cellular Rejection, n (%)||11 (10%)||1 (8%)||0.814|
|Any Pathology Antibody-Mediated Rejection, n (%)||19 (17%)||3 (23%)||0.577|
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Challenges and Clinical Outcomes in Cardiac Transplantation
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1309-311
- 2013 American College of Cardiology Foundation