title: Antithymocyte globulin induction therapy in heart transplantation: prospective randomized study of high vs standard dosage.
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.
  
  
  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.
authors.affiliation: Division of Cardiac Surgery, University of Verona, Verona, Italy. Giuseppe.faggian@univr.it
authors.forename: G
authors.initials: G
authors.lastname: Faggian
authors.forename: A
authors.initials: A
authors.lastname: Forni
authors.forename: A D
authors.initials: AD
authors.lastname: Milano
authors.forename: B
authors.initials: B
authors.lastname: Chiominto
authors.forename: B H
authors.initials: BH
authors.lastname: Walpoth
authors.forename: T
authors.initials: T
authors.lastname: Scarabelli
authors.forename: A
authors.initials: A
authors.lastname: Mazzucco
mesh_terms: D000208:Acute Disease; D000328:Adult; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D002908:Chronic Disease; D003141:Communicable Diseases / Q000209:etiology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007430:Intraoperative Care; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology; D011446:Prospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents