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

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.