Improved long-term results with thymoglobuline induction therapy after cardiac transplantation: A comparison of two different rabbit-antithymocyte globulines

Background The aim of this retrospective single center analysis was to comp are possible long-term benefits of two different rabbit-antithymocyte globu line (ATG) induction therapies after cardiac transplantation. Patients and Methods. A total of 484 primary cardiac transplanted patients received induction therapy with two different rabbit-ATGs (thymoglobuline: n = 342, ATG-fresenius: n = 142). All patients received immunosuppressive m aintenance therapy with cyclosporine, azathioprine, and prednisolone. Cardi ac rejection was assessed by serial endomyocardial biopsies. Surveillance o f graft arteriosclerosis was performed by angiograms 1, 3, and 5 years afte r transplantation. Results. Five-year survival was significantly better in the thymoglobuline group (76 vs. 60%). Thymoglobuline patients had a lower rate of death from rejection (2.3 vs. 10%; P < 0,01) and graft arteriosclerosis (0.88 vs. 5.6% ; P < 0,01). After 5 years, freedom from rejection was 72% in the thymoglob uline group compared to 42% in the ATG-fresenius group (P < 0,01), Graft ar teriosclerosis appeared in 14% of thymoglobuline patients and in 28% of ATG -fresenius patients (P < 0.01). Viral infections occurred more often in thy moglobuline patients (53 vs. 39%, P < 0.05) although there was no differenc e in appearance of cytomegalovirus disease (17 vs. 13%). Freedom from postt ransplant malignant disease was comparable between the two groups. Conclusion. These results suggest that there are differences between rabbit ATG products. The superior prevention of rejection with thymoglobuline may be the reason for the lower rate of graft arteriosclerosis.