REDUCED INCIDENCE AND SEVERITY OF ACCELERATED GRAFT ATHEROSCLEROSIS IN CARDIAC TRANSPLANT RECIPIENTS TREATED WITH PROPHYLACTIC ANTILYMPHOCYTE GLOBULIN

Citation
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
Citations number
NO
Categorie Soggetti
Cardiac & Cardiovascular System",Surgery
ISSN journal
00219509
Volume
33
Issue
6
Year of publication
1992
Pages
746 - 753
Database
ISI
SICI code
0021-9509(1992)33:6<746:RIASOA>2.0.ZU;2-0
Abstract
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.