Purpose: Strategies for sensitized patients undergoing heart transplant include post-op anti-thymocyte globulin (ATG) induction therapy as well as intravenous immunoglobulin (IVIG). We sought to assess whether the combination of IVIG and ATG affects the development of donor-specific antibodies (DSA) post-heart transplant (HTx) and clinical outcomes.

Methods: Between 2010 and 2015, we assessed 585 heart transplant patients. Of these, 43 patients were treated with both ATG induction therapy and IVIG and 215 were treated with ATG alone. Endpoints included 2-year freedom from de novo DSA development, 2-year survival, and 2-year freedom from cardiac allograft vasculopathy as defined by ≥ 30% stenosis by angiography.

Results: The ATG and IVIG group compared to the ATG alone group had a significantly higher pre-transplant mean PRA (72.0% vs 58.3%, p=0.044). Patients given ATG and IVIG had a similar 2-year freedom from de novo DSA development (see table). There was no significant difference in 2-year survival or 2-year freedom from CAV between the groups.

Conclusion: Patients who were treated with both ATG and IVIG compared to ATG induction therapy alone had similar outcomes. However, the addition of IVIG to ATG may have had benefit as this group had significantly higher pre-transplant PRA in which 2-year de novo DSA development and clinical outcomes were similar between study groups. Longer follow-up is needed to confirm these findings.

CITATION INFORMATION: Patel J., Kittleson M., Kransdorf E., Levine R., Dimbil S., Geft D., Chang D., Czer L., Kobashigawa J. IVIG Induction May Be Helpful in Highly Sensitized Patients after Heart Transplantation Am J Transplant. 2017;17 (suppl 3).

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