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Induction Therapy With Thymoglobulin After Heart Transplantation: Impact of Therapy Duration on Lymphocyte Depletion and Recovery, Rejection, and Cytomegalovirus Infection Rates

Journal
The Journal of Heart and Lung Transplantation
Publisher
Elsevier
Publication Date
Jan 01, 2008
Volume
27
Issue
10
Identifiers
DOI: 10.1016/j.healun.2008.07.002
Disciplines
  • Biology
  • Medicine
License
Unknown

Abstract

Background This retrospective single-center study compared lymphocyte depletion in 144 heart transplant recipients using 2 different induction protocols with Thymoglobulin (Genzyme Transplant, Cambridge, MA). Methods Thymoglobulin (1.5 mg/kg) was given to 105 patients for 7 days (Thymo7) and 39 patients for 5 days (Thymo5). Results Patient clinical characteristics were similar except that the Thymo7 group had a higher prevalence of women (33% vs 15%, p = 0.04), gender mismatch (35% vs 19%, p = 0.07), donor African American race (19% vs 2%, p = 0.008), older donor age (35 ± 13 vs 31 ± 12, p = 0.08), and higher pre-transplant creatinine (1.43 ± 0.67 vs 1.25 ± 0.48 mg/dl, p = 0.095). Seventy-five percent of the Thymo7 group reached target (absolute lymphocyte count ≤200) and 42% at 21 days ( p = 0.002). Thymo7 patients had significantly lower rejection rates (≥1B) within the first year (7% vs 22%, p = 0.02). No humoral rejection occurred. At 1 year, freedom from rejection was 93% in the Thymo7 group vs 80% in the Thymo5 group ( p = 0.007), and cytomegalovirus disease (9% and 5%, p = 0.5) and bacterial infection (26% vs 32%, p = 0.5) were similar. One-year actuarial survival was 92% ± 3% in the Thymo7 and 100% in the Thymo5 group ( p = 0.07), and at 3 years, 85 ± 4% and 90 ± 6%, respectively ( p = 0.4). Conclusions Both Thymoglobulin regimens were well tolerated. The 7-day treatment led to more efficient and prolonged lymphocyte depletion and significantly less rejection at 1 year, without an increase in cytomegalovirus infection rate.

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