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Transplantation |

Antithymocyte Globulin Treatment for Bronchiolitis Obliterans Syndrome in Lung Transplant Recipients

Linda Stuckey, PharmD; Kathleen Welch, MS; Matthew Lewis, PharmD; Vibha Lama, MD; Tammy Ojo, MD; Catherine Bartos, RN; Heidi McCullough, RN; Ros Florn, RN; Jules Lin, MD; Kevin Chan, MD
Author and Funding Information

University of Michigan Hospital and Health Centers, Ann Arbor, MI


Chest. 2013;144(4_MeetingAbstracts):1010A. doi:10.1378/chest.1704901
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Abstract

SESSION TITLE: Lung Transplantation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Anti-thymocyte globulin (ATG) has proven efficacy in refractory acute rejection, but its role in bronchiolitis obliterans syndrome (BOS) has not been clearly defined. We describe the efficacy of this treatment for BOS.

METHODS: Patients (pts) transplanted between 1/99-1/10 at our institution who survived >6 mo and developed BOS were identified retrospectively. Variables collected included: demographics, CMV status, pre-transplant diagnosis, FEV1, acute rejection episodes, infections, and ATG regimen. ATG pts were matched to a non-ATG control cohort based on: the slope of FEV1 decline, single or double lung transplant, and stage of BOS (early or late). Pts were only included in the slope analysis if they survived >180 days after ATG. The slope of the FEV1 decline post-transplant was analyzed using a linear mixed model.

RESULTS: 141/322 pts transplanted over 11 years were included. The median time to BOS was 701 days (52-2890 days). 25 pts (18%) received ATG for BOS. 38 pts met matching criteria: 16 ATG to 22 controls. The slope of the FEV1 decline at 180 days (p=0.24; 10 ATG v. 12 controls), 5-year survival for all causes of death (p=0.31) or overall infection (p=0.58) was no different between groups. Death from respiratory causes (BOS and/or respiratory failure) was lower and trending towards significance in the ATG group at ≥180 days after therapy (HR 0.22.; 95% CI 0.04 to 1.18; p=0.078). This was not present <180 days after therapy (HR 1.41; 95% CI 0.556 to 3.62; p=0.47).

CONCLUSIONS: ATG treatment for BOS is not efficacious in preventing further FEV1 decline or overall patient survival in lung transplant recipients. It may reduce respiratory causes of death in patients who survive more than 180 days after therapy.

CLINICAL IMPLICATIONS: ATG does not provide a clear benefit for BOS. The decision to use ATG for BOS should be balanced against the risk of infection and adverse effects of this treatment modality.

DISCLOSURE: The following authors have nothing to disclose: Linda Stuckey, Kathleen Welch, Matthew Lewis, Vibha Lama, Tammy Ojo, Catherine Bartos, Heidi McCullough, Ros Florn, Jules Lin, Kevin Chan

No Product/Research Disclosure Information


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