The incidence of acute cellular rejection after lung transplantation: a comparative study of anti-thymocyte globulin and daclizumab.
OBJECTIVE
This study examined the effects of anti-thymocyte globulin (ATG) and daclizumab immunosuppressive induction therapy on the frequency and severity of acute cellular rejection in lung transplantation patients.


METHODS
A retrospective analysis was conducted of 335 lung transplantation patients from a single center in the period 1992 to 2003. Patients completed standard ATG (Merieux, 2.5 mg/kg/day, or ATGAM, 12.5 mg/kg/day, for 3 consecutive days) (n = 151) or daclizumab (5 fortnightly treatments at a dose of 1 mg/kg) (n = 151) induction therapy. End points included acute cellular rejection requiring treatment (> or = A2), and moderate/severe acute cellular rejection (A3/A4).


RESULTS
The percentage of patients free of rejection requiring treatment (< A2) was 32% at 3 months and 26% at 2 years after transplantation in the ATG group and 9% and 0%, respectively, in the daclizumab group (p < 0.0001). Compared with the ATG group, a significantly higher proportion of patients in the daclizumab group experienced 3 or more episodes of acute cellular rejection > or = A2 during the first 3 months (p < 0.0001) and the entire 2-year follow-up (p < 0.0001). The daclizumab group also experienced more moderate/severe acute cellular rejection episodes compared with the ATG group during the first 3 months (p = 0.005). Cox regression analysis demonstrated ATG induction therapy was independently associated with a significantly longer duration of freedom from acute cellular rejection requiring treatment (> or = A2) (p < 0.001).


CONCLUSIONS
After lung transplantation, ATG induction appears to be superior to daclizumab induction in the reduction in the incidence and severity of acute cellular rejection.
Burton
Christopher M
CM
Division of Lung Transplantation, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. cmburton@doctors.net.uk
Andersen
Claus B
CB
Jensen
Annette S
AS
Iversen
Martin
M
Milman
Nils
N
Boesgaard
Søren
S
Arendrup
Henrik
H
Eliasen
Kirsten
K
Carlsen
Jørn
J
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D019540:Area Under Curve; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D000077561:Daclizumab; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control*; D016041:Heart-Lung Transplantation / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D016040:Lung Transplantation / Q000276:immunology*; D008232:Lymphoproliferative Disorders / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use; D016019:Survival Analysis
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D000077561:Daclizumab; D020123:Sirolimus