NO DEATHS, FEW REJECTIONS IN THE SHORT-TERM ASSESSMENT OF HEART TRANSPLANTATION USING ATG INDUCTION

Abstract

A201 Aims: The aim of this single centre analysis was to evaluate short term benefits of rabbit antihuman thymocyte globulin (rATG) induction therapy associated with cyclosporine, MMF and steroids, after cardiac transplantation. Methods: During 2003, there were 23 heart transplants carried out at Nantes hospital. Data on these 23 recipients was collected up to March 2004, giving a mean length of follow-up of 7.3 months (range: 1.3-13.3). Results: The mean donor age was 35.6 years (13-53), the mean ICU stay was 108 hours (24-500) and all these donors were hemodynamically stable. The recipients comprised 17 males and 6 females with a mean age of 45 years (13-64) and 41% were over age 50. The indications for transplantation were ischemic cardiomyopathy (11), dilated cardiomyopathy (10), valvular pathology (1) and congenital heart disease (1). Patient status before transplantation was poor : all of them had a grade IV NYHA status, 10 were still at home; 13 were hospitalised, 4 of whom were on assisted circulation and 1 intubated. For all recipients, the cardiac transplantation was their first. The 23 grafts were flushed and cold stored with Celsior solution, the mean CIT was 2.9 hrs (1.7-4.2). Five patients needed a ventricular assist device. All patients received the first dose of rATG (Thymoglobuline, SangStat) after declamping on day 0, followed by daily infusions depending on E-rosette count for another 4 to 5 days (giving a mean first dose of 2.3 mg/kg and a mean cumulative dose of 5.45 mg/kg). Steroids started from D0, MMF (CellCept, Roche) and cyclosporine (Neoral, Novartis) had delayed introduction with the mean start day being 5-6 and 2-3 respectively (cyclosporine was started when creatinine <200 μmol/l). All patients received antibacterial and antifungal prophylaxis, antiviral prophylaxis was based on donor/recipient CMV status. Thymoglobuline tolerability was good: no anaphylaxis, no first dose syndrome and no thrombocytopenia or neutropenia necessitating temporary discontinuation of the product. The mean recipients’ ICU stay was 12.5 days (4-57). Only 12 patients suffered at least one infection which included 5 pneumonias (2 with septicaemia, 1 with septicaemia and mediastinitis). No malignancies occurred. Only one patient (4.3%) experienced rejection (two consecutive grade 2 acute rejections, both resolved after steroid treatment). At the end of follow-up period, all patients were alive with a grade I NYHA status, mean serum creatinine 118 μmol/l (69-187) and none required dialysis. In the same year, 3 patients received Heart-Lung transplants and 5 Lung transplants. The same immunosuppressive regimen was followed. All these patients were also still living at March 2004. Conclusions: In conclusion, the use of Thymoglobuline combined with cyclosporine, MMF and steroids in the protocol described above, results in excellent efficacy over this short follow-up with 100% graft and patient survival, few side effects and few rejections. The low rejection rate in combination with a low infection rate suggests optimal immunosuppression with this regimen.