title: Induction Therapy With Antithymocyte Globulin in Patients Undergoing Cardiac Transplantation Is Associated With Decreased Coronary Plaque Progression as Assessed by Intravascular Ultrasound.
abstract: BACKGROUND
  Antithymocyte globulin (ATG) is used as induction therapy after cardiac transplant for enhancing immunosuppression and delaying the initiation of nephrotoxic drugs. It is unknown if ATG induction is associated with decreased coronary plaque progression by intravascular ultrasound (IVUS).
  
  
  RESULTS
  Patients transplanted between March 2010 and December 2012 with baseline and 1-year IVUS were included. All patients transplanted were included in a secondary analysis. Change in plaque progression was measured in a blinded fashion on matched coronary segments and contrasted between patients induced with ATG and those who were not. One hundred and three patients were included in IVUS arms. Mean age at transplant was 55.8 ± 12.6 years, and 33.0% were female. Patients induced with ATG were more sensitized (54.3% versus 14.3%). Plaque progression was attenuated in patients who received ATG by changes in maximal intimal area (1.0 ± 1.2 versus 2.3 ± 2.6 mm(2); P = 0.001), maximal percent stenosis (6.3 ± 7.9 versus 12.8 ± 12.3%; = 0.003), maximal intimal thickness (0.2 ± 0.2 versus 0.3 ± 0.3 mm; P = 0.035), and plaque volume (0.5 ± 0.7 versus 1.0 ± 1.3 mm(3)/mm; P = 0.016). Rapid plaque progression by maximal percent stenosis (≥ 20%) occurred less frequently in the ATG arm (4.3% versus 26.3; P = 0.003). Survival (P = 0.242) and any treated rejection (P = 0.166) were not statistically different between groups. Patients receiving ATG had a higher rate of first-year infection (P = 0.003), perhaps related to increased intravenous antibiotic use immediately postoperatively, and a trend toward more biopsy-proven rejection (P = 0.073).
  
  
  CONCLUSIONS
  Induction therapy with ATG is associated with reduced first-year coronary plaque progression as assessed by IVUS, despite an increased prevalence of sensitized patients with a trend toward more rejection.
authors.affiliation: From the Cedars-Sinai Heart Institute, Los Angeles, CA. azarbalb@cshs.org.
authors.forename: Babak
authors.initials: B
authors.lastname: Azarbal
authors.affiliation: From the Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: Richard
authors.initials: R
authors.lastname: Cheng
authors.affiliation: From the Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Vanichsarn
authors.affiliation: From the Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: Jignesh K
authors.initials: JK
authors.lastname: Patel
authors.affiliation: From the Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Czer
authors.affiliation: From the Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: David H
authors.initials: DH
authors.lastname: Chang
authors.affiliation: From the Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Kittleson
authors.affiliation: From the Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: Jon A
authors.initials: JA
authors.lastname: Kobashigawa
mesh_terms: D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D003141:Communicable Diseases / Q000453:epidemiology / Q000276:immunology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects*; D018450:Disease Progression; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents
keywords: allografts; biopsy; immunosuppression; incidence; prevalence