Delayed onset of cardiac allograft vasculopathy by induction therapy using anti-thymocyte globulin.

BACKGROUND

In this study we sought to compare the long-term effects of anti-thymocyte globulin (ATG) and muromonab-CD3 (OKT3) as induction therapy after heart transplantation, with special regard to cardiac allograft vasculopathy (CAV), post-transplant infections, post-transplant non-skin cancers and patient survival.

METHODS

From 1988 to 1991, 25 heart transplant patients received OKT3 as induction treatment. Accordingly, 25 consecutive patients who received ATG and 25 consecutive patients without induction therapy were enrolled.

RESULTS

At a follow-up period of 13.4 +/- 4.6 years, time to onset of non-significant and significant CAV was 8.77 +/- 3.38 and 11.60 +/- 4.28 years, respectively, in the ATG group, which was significantly delayed compared with 5.71 +/- 3.08 and 7.44 +/- 2.74 years, respectively, in the non-induction group. In the OKT3 group, time to onset of non-significant and significant CAV (6.10 +/- 2.73 and 7.86 +/- 3.19 years, respectively) did not differ significantly from the non-induction group. Ten- and 15-year actuarial survival rates of ATG- and OKT3-treated patients were not significantly different from those of patients without induction treatment.

CONCLUSIONS

Our study suggests the long-term advantage of ATG in prevention of cardiac allograft vasculopathy. In contrast, OKT3 failed to show such benefit. However, induction therapy with either ATG or OKT3 did not exhibit a significant beneficial effect on long-term patient survival.