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19 June 2018 : Original article  

Outcomes of Induction Therapy with Rabbit Anti-Thymocyte Globulin in Heart Transplant Recipients: A Single Center Retrospective Cohort Study

Tambi Jarmi1ACDEF*, Nirav Patel2BCD, Sadaf Aslam1ADEF, George Makdisi3DE, Elias Doumit1DE, Rahul Mhaskar1DE, Branko Miladinovic1CD, Mark Weston4ADEF

DOI: 10.12659/AOT.907984

Ann Transplant 2018; 23:422-426

Abstract

BACKGROUND: Induction immunosuppression is used in transplantation to prevent early acute rejection. The survival benefit of rabbit anti-thymocyte globulin (rATG) induction has not been established yet. We sought to determine the role of rATG in preventing rejection and improving overall survival.

MATERIAL AND METHODS: A retrospective cohort study was conducted from 2005 to 2009 and data of consecutive 268 heart transplant recipients were reviewed.

RESULTS: The data of 144 patients who received induction with rATG were compared to 124 patients who did not. Although overall survival was not different between the 2 groups (P=0.12), there was a significant difference in restricted mean survival time (RMST) at 5 years (RMST=4.8 months; 95% CI: 1.0–8.6, P=0.01) and 10 years (RMST=10.4 months; 95% CI: 1.6–19.3, P=0.02) in favor of the non-induced patients. No difference was observed between induced and non-induced patients who developed de novo donor specific antibodies. There was a significant difference in median days to first rejection in favor of the induced group (P<0.001).

CONCLUSIONS: Induction with rATG adds no survival benefit in heart transplant recipients. Patients who did not receive induction therapy had higher life expectancy at 5 years and 10 years. Although there was significant delay in the first rejection episode in favor of the rATG induced group, no difference was observed in donor specific antibodies. This study indicates a need for separate analysis of peri-transplantation co-morbidities and mainly the incidence of acute kidney injury, which could affect long-term survival.

Keywords: Graft Rejection, Heart Transplantation, Survival

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358