Antithymocyte globulin induction therapy for adult heart transplantation: A UK national study

Emin, A; Rogers, Chris; Thekkudan, Joyce; Bonser, Robert S.; Banner, Nicholas R.

doi:10.1016/j.healun.2011.01.716

Cited by 35 publications

(21 citation statements)

References 24 publications

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“…In one analysis from the CTS, Opelz et al reported that ATG induction (including all ATG preparations) 'did not confer an added risk for lymphoma' in heart transplant recipients, but further information was not provided [9]. A prospective cohort study of all UK transplant centers has reported rates of death due to malignancy following heart transplantation according to whether patients received ATG of any type, or no ATG [57]. The population of 2086 patients was transplanted during 1995 to 2008, and thus represents a relatively recent cohort.…”

Section: Registry Findings: Nhlmentioning

confidence: 99%

Rabbit antithymocyte globulin induction and risk of post-transplant lymphoproliferative disease in adult and pediatric solid organ transplantation: An update

Hertig

Zuckermann

2015

Transplant Immunology

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The most modifiable risk factor for post-transplant lymphoproliferative disease (PTLD) is the type and dose of induction and maintenance immunosuppressive therapy. It is challenging to identify the contribution of a single agent such as rabbit antithymocyte globulin (rATG) in the setting of multidrug therapy. Registry analyses can be helpful but are limited by methodological restrictions and inclusion of historical patient cohorts. These are typically from eras when rATG dosing was markedly higher than current dosing (e.g. total dose 14 mg/kg versus 6 mg/kg now), accompanied by higher exposure to maintenance therapies, and often an absence of antiviral prophylaxis. The largest registry analysis to assess rATG specifically found no risk of PTLD after kidney transplantation, but conflicting results have been reported, highlighting the difficulty of interpreting this type of analysis. The relative rarity of PTLD means that individually controlled trials are underpowered to assess its occurrence, but the available data do not suggest an effect of rATG. A pooled analysis of data from studies of rATG induction in kidney and heart transplantation found the incidence of PTLD to be comparable to published reports in the overall transplant population. Data on the effect of rATG dose are inconclusive, but in patients receiving antiviral prophylaxis it does not appear to be influential. Nevertheless, it would seem reasonable to employ the lowest dose of rATG compatible with effective induction, particularly in EBV-seronegative recipients and other high-risk groups such as heart-lung transplant recipients. Overall, the risk of PTLD following rATG induction therapy with modern dosing regimens and under current management conditions appears unlikely to make an important contribution to the risk:benefit balance.

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Section: Registry Findings: Nhlmentioning

confidence: 99%

Rabbit antithymocyte globulin induction and risk of post-transplant lymphoproliferative disease in adult and pediatric solid organ transplantation: An update

Hertig

Zuckermann

2015

Transplant Immunology

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“…This finding is in accordance with the newer analyses of registries. Emin et al [32 ] did not find any evidence of increased mortality from lymphoma in the ATG group in adult heart transplant recipients. Gajarski et al [33 ] described a lower risk for posttransplantation lymphoproliferative disease (PTLD) development in a cohort of 2374 pediatric patients (1258 with induction) in those patients who were treated with induction (RR 0.5; P ¼ 0.009).…”

Section: Cancermentioning

confidence: 90%

“…A recent analysis of the UK national registry (2086 patients) showed a higher incidence of infection with ATG-induction compared with no induction in adults during the first year after transplant [32 ]. However, data from a multicenter registry in pediatric patients showed that overall, induction was not associated with an increased infection risk [33 ].…”

Section: Infectionmentioning

confidence: 99%

Is induction therapy still needed in heart transplantation?

Aliabadi

Grömmer²,

Zuckermann³

2011

Current Opinion in Organ Transplantation

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“…It is used in heart transplantation as induction immunosuppression for prevention of rejection episodes with a low rate of early and late complications. 9,11,12 Frequent side effects of RATG as leukopenia, thromobocytopenia, and increased risk of infections have also been described with other immunosuppressant therapies used in GCM. In our patients, thrombocytopenia was the most common side effect occurring in 5, but only 2 cases were severe.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Rabbit Anti-thymocyte Globulin in Patients With Giant Cell Myocarditis

Suárez-Barrientos

Wong

Bell

et al. 2015

The American Journal of Cardiology

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Antithymocyte globulin induction therapy for adult heart transplantation: A UK national study

Cited by 35 publications

References 24 publications

Rabbit antithymocyte globulin induction and risk of post-transplant lymphoproliferative disease in adult and pediatric solid organ transplantation: An update

Rabbit antithymocyte globulin induction and risk of post-transplant lymphoproliferative disease in adult and pediatric solid organ transplantation: An update

Is induction therapy still needed in heart transplantation?

Usefulness of Rabbit Anti-thymocyte Globulin in Patients With Giant Cell Myocarditis

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