Author + information
- Parham Zarrini,
- Tamar Aintablian,
- Michelle Kittleson,
- David Chang,
- Dael Geft,
- Lawrence Czer and
- Jon Kobashigawa
Ischemia reperfusion injury after heart transplant (Htx) is not uncommon. This may lead to rejection and endothelial cells dysfunction with subsequent development of cardiac allograft vasculopathy (CAV). It has been reported that the use of anti-thymocyte globulin (ATG) as induction therapy post-tx may lessen the ischemia reperfusion injury that occurs to donor hearts. This has not been confirmed.
Between 2010 and 2013, we assessed 330 Htx patients and divided them into those who received induction with ATG versus those who did not. In our program ATG is given to patients who are sensitized or have baseline serum creatinine>2.0 mg/dl (to delay initiation of tacrolimus).Weekly endomyocardial biopsy samples were reviewed for the first month after Htx for ischemia reperfusion injury. First yr outcomes included survival, freedom from any treated rejection, and freedom from CAV (stenosis>= 30%).
Patients who underwent induction therapy with ATG had significantly greater freedom from any ischemia reperfusion injury noted on weekly endomyocardial biopsies in the first month post Htx (74.8% vs 63.5%, p=0.019). There was no difference between the two groups in first-yr survival, freedom from any treated rejection and CAV (see table).
ATG as induction therapy appears to provide protection against ischemia reperfusion injury in donor heart. Longer follow-up is needed to show potential outcomes benefit. This finding should be confirmed in a randomized clinical trial.
|Endpoints||No Induction Therapy (N=201)||ATG Induction Therapy (N=129)||P-Value|
|Freedom from Any Ischemia Reperfusion Injury on Heart Biopsy Biopsy in the First Month Post-Transplant||63.5%||74.8%||0.019|
|1-Year Actual Survival||91.0%||94.1%||0.356|
|1-Year Actual Freedom from CAV||91.9%||93.1%||0.719|
|1-Year Actual Freedom from Any Treated Rejection||84.8%||82.4%||0.660|
Poster Area, South Hall A1
Sunday, April 03, 2016, 9:45 a.m.-10:30 a.m.
Session Title: Heart Failure and Cardiomyopathies: Transplantation/Stem Cells/Catheter Based Therapies
Abstract Category: 27. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1172-084
- 2016 American College of Cardiology Foundation