Challenging Dogma That Anti-Thymocyte Globulin Induction with Delayed Calcineurin Inhibitor Benefits Patients with Renal Insufficiency Undergoing Heart Transplant
Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
Meeting: 2020 American Transplant Congress
Abstract number: 181
Keywords: Heart/lung transplantation, Immunosuppression
Session Information
Session Name: Heart Transplantation: It's All About the Outcomes
Session Type: Oral Abstract Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 3:39pm-3:51pm
Location: Virtual
*Purpose: Anti-thymocyte globulin (ATG) induction is used in approximately 50% of heart transplant (HTx) patients in the United States to induce tolerance. Other programs only use ATG for patients who have renal insufficiency where initiation of calcineurin inhibitor (CNI) is delayed in order to prevent renal deterioration. It is not clear as to whether ATG induction truly benefits these patients with renal insufficiency.
*Methods: Between 2010 and 2018 we assessed our HTx patients undergoing heart transplant with renal insufficiency which was defined as glomerular filtration rate (GFR)<50ml/min. Those patients with GFR<30ml/min underwent combined heart/kidney transplant. Therefore, the remaining patients were divided to the following groups: GFR 30-40ml/min (n=78) and GFR 41-50ml/min (n=76). Dual organ heart and kidney transplant patients were excluded from analysis. Within each group, patients were divided into those with and without ATG induction therapy. Those patients given ATG (x 5 days) had delayed CNI beginning on days 3-5 post-operative once urine output is established. Endpoints included GFR at baseline, 3 months, 6 months and 12 months postop. 1-year freedom from temporary and chronic dialysis (occurring greater than 90 days postop) and freedom from rejection (any treated rejection (ATR), acute cellular rejection (ACR), antibody mediated rejection (AMR)) were recorded.
*Results: In both the GFR 30-40ml/min group and the 41-50ml/min group, there was no difference in GFR between those given ATG and those without at 3,6,12 months post-op. The GFR 30-40ml/min with ATG group compared to no ATG group had significantly lower freedom from chronic dialysis. The GFR 41-50ml/min with ATG group compared to no ATG group had significantly lower freedom from temporary dialysis. There was no difference in first year rejections within both groups (with and without ATG).
*Conclusions: ATG induction with delayed CNI administration does not appear to have renal sparing benefit in those patients with reduced GFR at the time of transplant.
To cite this abstract in AMA style:
Kittleson M, Patel J, Chang D, Kransdorf E, Geft D, Nishihara K, Shen A, Velleca A, Czer L, Esmailian F, Kobashigawa J. Challenging Dogma That Anti-Thymocyte Globulin Induction with Delayed Calcineurin Inhibitor Benefits Patients with Renal Insufficiency Undergoing Heart Transplant [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/challenging-dogma-that-anti-thymocyte-globulin-induction-with-delayed-calcineurin-inhibitor-benefits-patients-with-renal-insufficiency-undergoing-heart-transplant/. Accessed May 16, 2025.« Back to 2020 American Transplant Congress