BACKGROUND: Heart transplant recipients who are sensitized pre-transplant are at increased risk for the development of antibody mediated and cellular rejection post transplantation. The use of induction therapy with anti-thymocyte globulin (ATG) may reduce the incidence of antibody mediated rejection (AMR), but this has not been formally studied in a randomized controlled trial. The purpose of this study was to determine the impact of ATG induction on the incidence of AMR in a large single-center experience.

METHODS: We identified 170 heart transplant (HTx) patients transplanted between January 1994 and October 2011, with pre-transplant panel reactive antibodies (PRA) >10%. Induction therapy was given based on the treating physician's preference. One-year outcomes were assessed, including the incidence of treated rejection and pathology-defined AMR.

RESULTS: Of the 170 HTx, 91 received ATG induction and 79 did not. The mean pre-transplant PRA was significantly higher in the ATG group (59 ± 31% vs 43 ± 32%, p=0.0015). In the ATG induction group, there were fewer treated rejection episodes (14% vs 30%, p= 0.010) and fewer pathology-defined AMR episodes (12% vs 26%, p=0.016). There was no difference in the incidence of cellular rejection (12% in both groups).

CONCLUSION: ATG induction therapy for sensitized patients results in fewer treated rejection episodes and a decreased incidence of pathology-defined AMR. This suggests that ATG induction may be beneficial in sensitized patients, but the results should be confirmed with a randomized trial.

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