Does Antibody Induction Immunotherapy Prevent the Development of Cardiac Allograft Vasculopathy?

Abstract

Purpose: Data on long-term outcomes after antibody induction immunotherapy (INIT) in heart transplantation (HT) is limited. We analyzed the relationship between INIT and the development of cardiac allograft vasculopathy (CAV) using the OPTN/UNOS database. Methods: Records of patients receiving HT after 12/31/1993 with recorded values for first-year rejection, CAV, and follow-up status were identified from the OPTN database. Patients receiving multi-organ transplants and more than one previous HT were excluded. Follow-up records were collapsed to a single entry for each patient using a Perl script. Univariate Cox proportional hazards analysis was used to identify covariates associated with the development of CAV. Factors with significant association (p<0.05) were entered into the final multivariable Cox proportional hazards model with CAV at five years after HT as endpoint. Results: We identified 23,535 patients in the database with 46.9% receiving INIT therapy.Figure: No Caption available.Mean follow-up time was 5.99 years (range 0.75 to 18.57 years). Characteristics of patients receiving INIT were significantly different than those not receiving INIT for all covariates. After adjusting for nine covariates that affect the risk of CAV, use of anti-thymocyte globulin (ATG) and alemtuzumab were significantly associated with reduced risk of CAV as compared to no INIT, whereas use of muromonab was significantly associated with an increased risk of CAV.Table: No Caption available.Conclusion: INIT with ATG and alemtuzumab prevent the development of CAV after HT. Use of INIT therapy should be considered in patients at elevated risk for CAV.