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Antithymocyte globulin induction therapy in heart transplantation: prospective randomized study of high vs standard dosage

Faggian, G.
Forni, A.
Milano, A. D.
Chiominto, B.
Scarabelli, T.
Mazzucco, A.
Published in Transplantation Proceedings. 2010, vol. 42, no. 9, p. 3679-3687
Abstract BACKGROUND: In cardiac transplantation, high-dose antithymocyte globulin (ATG) induction therapy as short-term rejection prophylaxis has not been used. OBJECTIVE: To evaluate the efficacy and safety of intraoperative use of single high-dose ATG induction therapy after heart transplantation. PATIENTS AND METHODS: Fourteen patients received single high-dose ATG therapy plus shortened standard therapy (group1), and 16 patients received ATG standard therapy (group2). RESULTS: No perioperative deaths were reported. During follow-up, 3 deaths were recorded. Five-year patient survival was 92.8% in groupl vs 85.7% in group2 (P = .34). The mean (SD) number of acute rejection episodes per patient was 2.5 (2.2) in the high-dose ATG group vs 2.7 (2.5) in the standard therapy group (P = .83), with 5-year freedom from acute rejection of 45.5% in group 1 vs 35.6% in group 2 (P = .85). Infections were observed in 6 patients in group1 and in 8 patients in group2 (P = .69). Malignant disease was diagnosed in 1 patient in the high-dose group and 3 patients in the standard therapy group (P = .35). Chronic allograft vasculopathy was recognized in 4 patients (28%) in group1 and 8 (50%) in group2 (P = .05). Five-year actuarial freedom from allograft vasculopathy was 69.2% in the high-dose ATG group vs 50.0%% in the standard therapy group (P = .35). CONCLUSIONS: High-dose ATG for prevention of rejection episodes is safe and efficacious, with a lower rate of early and late complications, in particular, graft vasculopathy.
Keywords Acute DiseaseAdultAntilymphocyte Serum/*administration & dosageChronic DiseaseCommunicable Diseases/etiologyDrug Administration ScheduleDrug Therapy, CombinationFemaleGraft Rejection/immunology/mortality/*prevention & controlGraft Survival/*drug effects*Heart Transplantation/adverse effects/mortalityHumansImmunosuppressive Agents/*administration & dosageIntraoperative CareKidney Failure, Chronic/etiologyMaleMiddle AgedNeoplasms/etiologyProspective StudiesTime FactorsTransplantation, HomologousTreatment Outcome
PMID: 21094838
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FAGGIAN, G. et al. Antithymocyte globulin induction therapy in heart transplantation: prospective randomized study of high vs standard dosage. In: Transplantation Proceedings, 2010, vol. 42, n° 9, p. 3679-3687. doi: 10.1016/j.transproceed.2010.06.036 https://archive-ouverte.unige.ch/unige:20928

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Deposited on : 2012-05-23

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