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* From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (Drs. Palmer and Tapson), and the Division of Cardiothoracic Surgery, Department of Surgery (Drs. Gaynor and Davis and Mss. Miralles and Lawrence), Duke University Medical Center, Durham, NC.
Correspondence to: Scott M. Palmer, MD, Pulmonary and Critical Care Medicine, Duke University Medical Center, Box 3221, Bell Bldg, Durham, NC 27710; e-mail: palme002{at}mc.duke.edu
Study objectives: The efficacy of antithymocyte induction therapy in lung transplantation is controversial, and its use varies from center to center. We hypothesized that rabbit antithymocyte globulin (RATG) induction therapy would decrease acute rejection after lung transplantation, and we designed a single-center, randomized, prospective study to test this hypothesis.
Design: A total of 44 single or bilateral adult lung transplant recipients were randomly assigned to receive either RATG induction therapy (dosage, 1.5 mg/kg/d for 3 days) at the time of transplantation, along with conventional immunosuppression (cyclosporine, azathioprine, and prednisone), or conventional immunosuppression alone with no induction therapy.
Results: Although a similar number of biopsies were performed in each group, the number of patients experiencing biopsy-proven grade II or greater acute rejection was significantly reduced in the group receiving RATG induction therapy (23% incidence), as compared to the patients treated with conventional immunosuppression alone (55% incidence; p = 0.03). In addition, there was a nonsignificant reduction in the incidence of bronchiolitis obilterans syndrome at the conclusion of the study in patients who received RATG induction (20%), as compared to patients in the control group (38%). The incidence of posttransplant infections and malignancies were similar between the two groups.
Conclusion: Induction therapy with RATG significantly reduces the incidence of acute allograft rejection after lung transplantation.
Key Words: acute rejection • antithymocyte globulin • lung transplantation • obliterative bronchiolitis
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