Induction of immunosuppression with rabbit antithymocyte globulin: five-year experience in cardiac transplantation.

Perioperative induction of immunosuppressive treatment with rabbit antithymocyte globulin (RATG) and late introduction of cyclosporine was used in a group of 77 patients to prevent early renal dysfunction related to cyclosporine. Peak value in plasma creatinine during hospitalization for transplantation averaged 148 +/- 49 mmol/L in patients treated with RATG compared with 215 +/- 21 mmol/L in 39 patients initially treated without RATG induction (P = 0.01). Of patients treated with RATG, 65 +/- 6% remained free from acute rejection at six months versus 40 +/- 8% of untreated patients (P = 0.03). Rates of freedom from infection, from allograft coronary artery disease and from cancer are similar in both groups. Actuarial survival rates were identical in the two groups. The total number of lymphocytes, the percentage of T lymphocytes and of helper T cells were significantly lower when RATG was used. In conclusion, RATG prophylaxis given immediately after transplantation was well tolerated without complication and resulted in adequate immunosuppression to allow delayed introduction of maintenance treatment with cyclosporine.