Abstract
<h3>Purpose</h3> Ischemia reperfusion injury after heart transplant is not uncommon. This may lead to rejection and endothelial cell 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-transplant may lessen the ischemia reperfusion injury that occurs to donor hearts. This has not been confirmed. <h3>Methods</h3> Between 2010 and 2020, we assessed 1082 heart transplant 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 heart transplantation for ischemia reperfusion injury. First year outcomes included survival and freedom from CAV (stenosis ≥30%). <h3>Results</h3> 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-transplant. There was no difference between the two groups in first-year survival and freedom from CAV. <h3>Conclusion</h3> ATG as induction therapy appears to provide protection against ischemia reperfusion injury in donor hearts. Longer follow-up is needed to show potential outcomes benefit. This finding should be confirmed in a randomized clinical trial.
Published Version
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