title: Use of Anti-Thymocyte Globulin for Induction Therapy in Cardiac Transplantation: A Review.
abstract: The most common causes of death after heart transplantation (HTx) include acute rejection and multi-organ failure in the early period and malignancy and cardiac allograft vasculopathy (CAV) in the late period. Polyclonal antibody preparations such as rabbit anti-thymocyte globulin (ATG) may reduce early acute rejection and the later occurrence of CAV after HTx. ATG therapy depletes T cells, modulates adhesion and cell-signaling molecules, interferes with dendritic cell function, and induces B-cell apoptosis and regulatory and natural killer T-cell expansion. Evidence from animal studies and from retrospective clinical studies in humans indicates that ATG can be used to delay calcineurin inhibitor (CNI) exposure after HTx, thus benefiting renal function, and to reduce the incidence of CAV and ischemia-reperfusion injury in the transplanted heart. ATG may reduce de novo antibody production after HTx. ATG does not appear to increase cytomegalovirus infection rates with longer prophylaxis (6-12 months). In addition, ATG may reduce the risk of lymphoproliferative disease and does not appear to confer an additive effect on acquiring lymphoma after HTx. Randomized, controlled trials may provide stronger evidence of ATG association with patient survival, graft rejection, renal protection through delayed CNI initiation, as well as other benefits. It can also help establish optimal dosing and patient criteria to maximize treatment benefits.
authors.affiliation: Division of Cardiology, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: V
authors.initials: V
authors.lastname: Ruan
authors.affiliation: Division of Cardiology, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: lawrence.czer@cshs.org.
authors.forename: L S C
authors.initials: LS
authors.lastname: Czer
authors.affiliation: Division of Cardiology, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: M
authors.initials: M
authors.lastname: Awad
authors.affiliation: Division of Cardiology, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: M
authors.initials: M
authors.lastname: Kittleson
authors.affiliation: Division of Cardiology, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: J
authors.initials: J
authors.lastname: Patel
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: F
authors.initials: F
authors.lastname: Arabia
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: F
authors.initials: F
authors.lastname: Esmailian
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: D
authors.initials: D
authors.lastname: Ramzy
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: J
authors.initials: J
authors.lastname: Chung
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: M
authors.initials: M
authors.lastname: De Robertis
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: A
authors.initials: A
authors.lastname: Trento
authors.affiliation: Division of Cardiology, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: J A
authors.initials: JA
authors.lastname: Kobashigawa
mesh_terms: D000917:Antibody Formation; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D001402:B-Lymphocytes / Q000276:immunology; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000188:drug therapy; D006084:Graft Rejection / Q000276:immunology; D006331:Heart Diseases / Q000276:immunology / Q000601:surgery; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D060828:Induction Chemotherapy / Q000379:methods; D055611:Natural Killer T-Cells / Q000276:immunology; D015427:Reperfusion Injury / Q000188:drug therapy; D012189:Retrospective Studies
chemical_list: D000961:Antilymphocyte Serum; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents