Abstract
<h3>Purpose</h3> Rabbit anti-thymocyte globulin (ATG) therapy has been used for induction to allow delay of initiation of calcineurin inhibitor (CNI) immediately post-heart transplant (HTx) in patients with moderate to severe renal insufficiency. In our program, this approach has been routine for patients with serum creatinine >2.0 mg/dL. Although this mode of therapy has been shown to be effective for renal protection, its benefit has not been established for patients with less renal insufficiency, in the 1.5-2.0 mg/dL range. Therefore, we reviewed our patient population to assess whether ATG induction was renal-protective for these patients. <h3>Methods</h3> Between 2010 and 2020, we assessed 84 patients with baseline creatinine in the 1.5-2.0 mg/dL range who underwent HTx, and divided them into those who underwent ATG with delay of initiation from CNI to those patients who did not. Patients given ATG (x 5 days) had delayed CNI beginning on days 3-5 post-operatively once urine output was established. Endpoints included comparison of glomerular filtration rate (GFR) at baseline, with change at 6- and 12-months for each group. In addition, 1-year freedom from temporary and chronic dialysis (occurring greater than 30 days postop) and freedom from rejection (any treated rejection [ATR], acute cellular rejection [ACR], antibody mediated rejection [AMR]) was assessed. <h3>Results</h3> There was no significant difference in the ATG induction compared to control in renal function (creatinine/GFR) at baseline and change in GFR at 6 months and 1 year post-HTx. In addition, there was no difference between groups in 1-year freedom from temporary or chronic dialysis, and freedom from ATR, ACR, or AMR. <h3>Conclusion</h3> ATG induction with delay of CNI does not appear beneficial for kidney function in patients with mild renal insufficiency. Larger studies are needed to confirm these findings.
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