Impact of Rabbit Antithymocyte Globulin Dose on Long-term Outcomes in Heart Transplant Patients
| Autor: | Günther Laufer, Barbara Steinlechner, Phillipp Opfermann, Farsad Eskandary, Doris Hutschala, Andreas Zuckermann, Martina Grömmer, O. Salameh, Arezu Aliabadi, Johannes Gökler, Daniela Dunkler |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Graft Rejection
Male medicine.medical_specialty Time Factors medicine.medical_treatment Kaplan-Meier Estimate 030230 surgery Communicable Diseases Gastroenterology Group A Drug Administration Schedule Group B 03 medical and health sciences 0302 clinical medicine Risk Factors Neoplasms Internal medicine Humans Medicine Antilymphocyte Serum Proportional Hazards Models Retrospective Studies Heart transplantation Transplantation Chi-Square Distribution business.industry Incidence (epidemiology) Graft Survival Hazard ratio Retrospective cohort study Middle Aged Confidence interval Surgery Treatment Outcome Austria Multivariate Analysis Heart Transplantation Female 030211 gastroenterology & hepatology business Immunosuppressive Agents |
| Zdroj: | Transplantation. 100:685-693 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0000000000000950 |
| Popis: | BACKGROUND Optimal dosing strategies have not been established for rabbit antithymocyte globulin (rATG) after heart transplantation, and there is currently wide variability in rATG regimens with respect to both dose and duration. METHODS In a retrospective, single-center analysis, 523 patients undergoing heart transplantation during 1996 to 2009 were stratified by cumulative rATG dose: less than 4.5 mg/kg (group A), 4.5 to 7.5 mg/kg (group B) or greater than 7.5 mg/kg (group C). RESULTS Survival at 1 year after transplantation was 80% in group A, 90% in group B, and 88% in group C (P = 0.062). Incidence of acute rejection per 1000 patient-years was significantly higher in group A (hazards ratio [HR], 54.8; 95% confidence interval [95% CI], 33.9-83.8) compared to groups B (19.6; 95% CI, 11.4-31.4) and C (23.6; 95% CI, 17.5-31.3). Incidence of severe infection 10 years after transplantation was higher in group C (45%) than groups A (37%) or B (23%) (P < 0.001); cytomegalovirus infection rates were 35%, 20% and 23%, respectively (P = 0.009). Multivariable Cox regression showed an HR of 0.51 (95% CI, 0.25-1.02) for acute rejection with group B versus group A, and 0.54 (95% CI, 0.33-0.88; P = 0.013) for severe infection. The rate of malignancy per 1000 patient-years was higher in groups B (13.85) and C (14.95) than group A (7.83). CONCLUSIONS These retrospective data suggest that a cumulative rATG dose of 4.5 to 7.5 mg/kg may offer a better risk-benefit ratio than lower or higher doses, with acceptable rates of infection and posttransplant malignancy. Prospective trials are needed. |
| Databáze: | OpenAIRE |
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