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Rabbit Antithymocyte Globulin Induction in Heart Transplant Recipients at High Risk for Rejection

Background: Induction with lymphocyte-depleting antibodies may improve allograft outcomes in heart transplant recipients who are at high immunologic risk for rejection. Methods: We conducted a single-center retrospective cohort study that compared outcomes between adult patients receiving rabbit ant...

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Autores principales: Kitto, Brent, Thai, Steven, Baetz, Brooke, Patel, Hamang M., Mandras, Stacy A., Desai, Sapna, Krim, Selim R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Academic Division of Ochsner Clinic Foundation 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238107/
https://www.ncbi.nlm.nih.gov/pubmed/34239371
http://dx.doi.org/10.31486/toj.20.0024
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author Kitto, Brent
Thai, Steven
Baetz, Brooke
Patel, Hamang M.
Mandras, Stacy A.
Desai, Sapna
Krim, Selim R.
author_facet Kitto, Brent
Thai, Steven
Baetz, Brooke
Patel, Hamang M.
Mandras, Stacy A.
Desai, Sapna
Krim, Selim R.
author_sort Kitto, Brent
collection PubMed
description Background: Induction with lymphocyte-depleting antibodies may improve allograft outcomes in heart transplant recipients who are at high immunologic risk for rejection. Methods: We conducted a single-center retrospective cohort study that compared outcomes between adult patients receiving rabbit antithymocyte globulin (rATG) induction vs no induction from 2011 through 2017. Key exclusion criteria were patients who did not receive tacrolimus and mycophenolate and patients who did not meet high immunologic risk criteria. Results: A total of 50 patients were included in the analysis. At 1 year, the composite primary outcome of ≥2R rejection as defined by the International Society for Heart and Lung Transplantation, any treated rejection, development of cardiac allograft vasculopathy, or graft loss was not different between groups (P=0.474). Serious infections were also similar between groups (P=0.963). In accordance with institutional guidelines, prednisone exposure was decreased in the rATG induction group at 1 month (24.04 mg ± 13.74 vs 35.18 mg ± 16.95; P=0.014). Conclusion: These results suggest that while rATG induction does not improve heart allograft outcomes, it may enable reducing early corticosteroid exposure in patients at high immunologic risk.
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spelling pubmed-82381072021-07-07 Rabbit Antithymocyte Globulin Induction in Heart Transplant Recipients at High Risk for Rejection Kitto, Brent Thai, Steven Baetz, Brooke Patel, Hamang M. Mandras, Stacy A. Desai, Sapna Krim, Selim R. Ochsner J Original Research Background: Induction with lymphocyte-depleting antibodies may improve allograft outcomes in heart transplant recipients who are at high immunologic risk for rejection. Methods: We conducted a single-center retrospective cohort study that compared outcomes between adult patients receiving rabbit antithymocyte globulin (rATG) induction vs no induction from 2011 through 2017. Key exclusion criteria were patients who did not receive tacrolimus and mycophenolate and patients who did not meet high immunologic risk criteria. Results: A total of 50 patients were included in the analysis. At 1 year, the composite primary outcome of ≥2R rejection as defined by the International Society for Heart and Lung Transplantation, any treated rejection, development of cardiac allograft vasculopathy, or graft loss was not different between groups (P=0.474). Serious infections were also similar between groups (P=0.963). In accordance with institutional guidelines, prednisone exposure was decreased in the rATG induction group at 1 month (24.04 mg ± 13.74 vs 35.18 mg ± 16.95; P=0.014). Conclusion: These results suggest that while rATG induction does not improve heart allograft outcomes, it may enable reducing early corticosteroid exposure in patients at high immunologic risk. Academic Division of Ochsner Clinic Foundation 2021 2021 /pmc/articles/PMC8238107/ /pubmed/34239371 http://dx.doi.org/10.31486/toj.20.0024 Text en ©2021 by the author(s); Creative Commons Attribution License (CC BY) https://creativecommons.org/licenses/by/4.0/©2021 by the author(s); licensee Ochsner Journal, Ochsner Clinic Foundation, New Orleans, LA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (creativecommons.org/licenses/by/4.0/legalcode) that permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
spellingShingle Original Research
Kitto, Brent
Thai, Steven
Baetz, Brooke
Patel, Hamang M.
Mandras, Stacy A.
Desai, Sapna
Krim, Selim R.
Rabbit Antithymocyte Globulin Induction in Heart Transplant Recipients at High Risk for Rejection
title Rabbit Antithymocyte Globulin Induction in Heart Transplant Recipients at High Risk for Rejection
title_full Rabbit Antithymocyte Globulin Induction in Heart Transplant Recipients at High Risk for Rejection
title_fullStr Rabbit Antithymocyte Globulin Induction in Heart Transplant Recipients at High Risk for Rejection
title_full_unstemmed Rabbit Antithymocyte Globulin Induction in Heart Transplant Recipients at High Risk for Rejection
title_short Rabbit Antithymocyte Globulin Induction in Heart Transplant Recipients at High Risk for Rejection
title_sort rabbit antithymocyte globulin induction in heart transplant recipients at high risk for rejection
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238107/
https://www.ncbi.nlm.nih.gov/pubmed/34239371
http://dx.doi.org/10.31486/toj.20.0024
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