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Use of Anti-Thymocyte Globulin for Induction Therapy in Cardiac Transplantation: A Review.

Abstract：

:The most common causes of death after heart transplantation (HTx) include acute rejection and multi-organ failure in the early period and malignancy and cardiac allograft vasculopathy (CAV) in the late period. Polyclonal antibody preparations such as rabbit anti-thymocyte globulin (ATG) may reduce early acute rejection and the later occurrence of CAV after HTx. ATG therapy depletes T cells, modulates adhesion and cell-signaling molecules, interferes with dendritic cell function, and induces B-cell apoptosis and regulatory and natural killer T-cell expansion. Evidence from animal studies and from retrospective clinical studies in humans indicates that ATG can be used to delay calcineurin inhibitor (CNI) exposure after HTx, thus benefiting renal function, and to reduce the incidence of CAV and ischemia-reperfusion injury in the transplanted heart. ATG may reduce de novo antibody production after HTx. ATG does not appear to increase cytomegalovirus infection rates with longer prophylaxis (6-12 months). In addition, ATG may reduce the risk of lymphoproliferative disease and does not appear to confer an additive effect on acquiring lymphoma after HTx. Randomized, controlled trials may provide stronger evidence of ATG association with patient survival, graft rejection, renal protection through delayed CNI initiation, as well as other benefits. It can also help establish optimal dosing and patient criteria to maximize treatment benefits.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Ruan V,Czer LS,Awad M,Kittleson M,Patel J,Arabia F,Esmailian F,Ramzy D,Chung J,De Robertis M,Trento A,Kobashigawa JA

doi

10.1016/j.transproceed.2016.11.034

subject

Has Abstract

pub_date

2017-03-01 00:00:00

pages

253-259

issue

2

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(16)30935-6

journal_volume

49

pub_type

杂志文章,评审

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