ATG Induction Improves Outcome for Sensitized Patients Who Have Undergone Heart Transplantation

Abstract

Purpose Heart transplant recipients who are sensitized pre transplant are at increased risk for the development of antibody mediated and cellular rejection post transplantation. The use of induction therapy with anti-thymocyte globulin (ATG) may reduce the incidence of antibody mediated rejection (AMR), but this has not been formally studied in a randomized controlled trial. The purpose of this study was to determine the impact of ATG induction on the incidence of AMR in a large single-center experience. Methods and Materials We identified 170 heart transplant (HTx) patients transplanted between January 1994 and October 2011, with pre-transplant panel reactive antibodies (PRA) >10%. Induction therapy was given based on the treating physician’s preference. One-year outcomes were assessed, including the incidence of treated rejection and pathology-defined AMR. Results Of the 170 HTx, 91 received ATG induction and 79 did not. The mean pre-transplant PRA was significantly higher in the ATG group (59 ± 31% vs 43 ± 32%, p=0.0015). In the ATG induction group, there were fewer treated rejection episodes (14% vs 30%, p= 0.01) and fewer pathology-defined AMR episodes (12% vs 26%, p=0.016). There was no difference in the incidence of cellular rejection (12% in both groups). Conclusions ATG induction therapy for sensitized patients results in fewer treated rejection epiosdes and a decreased incidence of pathology-defined AMR. This suggests that ATG induction is beneficial in sensitized patients, and the results should be confirmed with a randomized trial. No ATG (n=79) ATG (n=91) p-value All Treated Rejections, n (%) 24 (30%) 13 (14%) 0.01 Cellular Rejections, n (%) 10 (12%) 11 (12%) 0.74 Any-Treated AMR, n (%) 21 (26%) 11 (12%) 0.02