Ar. Dresdale et al., REDUCED INCIDENCE AND SEVERITY OF ACCELERATED GRAFT ATHEROSCLEROSIS IN CARDIAC TRANSPLANT RECIPIENTS TREATED WITH PROPHYLACTIC ANTILYMPHOCYTE GLOBULIN, Journal of Cardiovascular Surgery, 33(6), 1992, pp. 746-753
Allograft coronary artery disease (ACAD) is the major factor limiting
long-term survival of cardiac transplant recipients (CTRs). Although c
yclosporine based triple drug immunosuppression has not decreased the
occurrence of ACAD, some preliminary data suggests that prophylactic a
ntilymphocyte preparations may reduce the incidence of this problem. A
ll CTRs at Henry Ford Hospital have uniformly received prophylactic Mi
nnesota Antilymphocyte Globulin (ALG), thereby providing a unique oppo
rtunity to investigate this hypothesis. One hundred three CTRs were fo
llowed for a median duration of 34 months with annual angiograms begun
one year after transplant. Patients who died without an angiogram wer
e considered to have ACAD based on autopsy results or if their death w
as clinically suspicious. Ninety-two patients underwent at least one a
ngiogram. Fourteen patients had abnormal angiograms. Nine patients wer
e identified as having ACAD by non-angiographic criteria. Five had aut
opsy proven disease, 3 died suspiciously, and 1 underwent successful r
e-transplantation for ACAD. By Kaplan-Meier analysis, the risk of deve
loping ACAD was 12% in 1 year, 16% in 2 years, 22% in 3 years, 26% in
4 years, and 29% in 5 years. Risk of ACAD increased with older recipie
nt's age, higher triglyceride levels, and diabetes, but was not affect
ed by active CMV infection, number of acute rejection episodes, and HL
A mismatching. These results suggest that prophylactic ALG reduces the
occurrence of ACAD.