title: Antithymocyte globulin induction therapy for adult heart transplantation: a UK national study.
abstract: BACKGROUND
  Induction therapy with antithymocyte globulin (ATG) after heart transplantation (HTx) has never been assessed in a placebo-controlled randomized trial. We investigated trends in use of ATG and its relationship to outcome after HTx in a national cohort.
  
  
  METHODS
  Between July 1995 and March 2008, 2,151 adult HTxs were performed. Patients given OKT3 or an interleukin-2 receptor antagonist, repeat transplants, heterotopic, and multi-organ transplants were excluded, leaving 2,086 HTx for analysis. Of these, 1,143 (55%) received induction with ATG.
  
  
  RESULTS
  The proportion of patients given ATG increased from 26% in June 1995 to 75% in August 2007 (p < 0.01). The age and gender distributions of recipients and donors were similar in the ATG and non-ATG groups. Survival to 10 years was similar: 56.2% in the non-ATG group vs 55.9% in the ATG group (p = 0.95). The number of treated rejection episodes in the first year was lower in the ATG group (incidence rate ratio, 0.76; 95% confidence interval [CI], 0.68-0.85, p < 0.01), but the number of infective episodes was higher (incidence rate ratio, 1.18; 95% CI, 1.00-1.39, p = 0.048), and these differences remained after risk adjustment, with an adjusted incidence rate ratio of 0.85 (95% CI, 0.75-0.95, p < 0.01) and 1.21 (95% CI, 1.02-1.44; p = 0.027). Deaths due to infective causes were higher in the ATG group (p = 0.03).
  
  
  CONCLUSIONS
  There has been a trend towards an increased use of induction therapy. There was no change in overall survival, but ATG induction was associated with a decreased incidence of rejection and an increase in infection.
authors: Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom. aemin@rcseng.ac.uk
authors: Akan
authors: A
authors: Emin
authors: Chris A
authors: CA
authors: Rogers
authors: Joyce
authors: J
authors: Thekkudan
authors: Robert S
authors: RS
authors: Bonser
authors: Nicholas R
authors: NR
authors: Banner
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000009:adverse effects / Q000627:therapeutic use*; D002423:Cause of Death; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006084:Graft Rejection / Q000401:mortality / Q000517:prevention & control; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007239:Infections / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine