Rabbit antithymocyte globulin. A 10-year experience in cardiac transplantation

Area of Science:

• Immunology
• Cardiology
• Transplantation Medicine

Background:

• Rabbit antithymocyte globulin (rATG) is an investigational immunosuppressive agent for T-cell depletion.
• Long-term clinical experience with rATG in cardiac transplantation is limited.
• Comparative data with other immunosuppressive agents like horse antithymocyte globulin and OKT3 is needed.

Purpose of the Study:

• To review the 10-year experience with rabbit antithymocyte globulin in cardiac transplant recipients.
• To evaluate the efficacy and safety of different immunosuppression protocols involving rATG.
• To identify an optimal immunosuppressive induction therapy for cardiac transplantation.

Main Methods:

• Retrospective analysis of 155 non-bridge-to-transplant cardiac recipients.
• Patients divided into three groups based on immunosuppression protocols from 1979 to 1989.
• Group I: rATG, steroids, azathioprine; Group II: rATG, cyclosporine, steroids; Group III: rATG, cyclosporine, steroids, azathioprine.

Main Results:

• Group III demonstrated superior 1- and 3-year survival rates (94% and 88%, respectively).
• Group III showed improved freedom from rejection (30% at 1 year) and infection (50% at 1 year).
• Significant reduction in early bacterial, viral, and nocardial infections observed in Group III compared to Group I.

Conclusions:

• A combination of rabbit antithymocyte globulin, cyclosporine, steroids, and azathioprine is an effective immunosuppressive induction strategy.
• This protocol leads to favorable survival rates and reduced infectious complications in cardiac transplant recipients.
• Current protocol using rATG (200 mg IM for 3 days) shows minimal toxicity and significant T-cell reduction.