Comparison of Cyclosporine and Tacrolimus in Combination With Rabbit Antithymocyte Immunoglobulins as Induction Therapy in Cardiac Transplantation

Induction with rabbit antithymocyte immunoglobulins (RATG) for cardiac transplantation allows reduction of calcineurin inhibitor and reduces the incidence of acute rejection episodes (ARE). We compared induction with RATG combined with either cyclosporine (CsA) or tacrolimus (FK) in regard to the number of ARE in the first year after transplantation. We transplanted 111 patients from 2000 to 2008 including 61 who received CsA-RATG, and 19, FK-RATG. At 3 months and 1 year the CsA group displayed 3.29 ± 1.66 and 7.44 ± 2.45 ARE per patient of grade at least 1R respectively. The FK group showed 3.21 ± 1.71 and 8.13 ± 2.07 episodes per patient (P = .86 at 3 months; P = .32 at 1 year). Among ARE 2R or greater, the CsA group displayed 0.51 ± 0.70 and 0.91 ± 0.95 episodes per patient at 3 months and 1 year, while the FK group showed 0.15 ± 0.38 and 0.31 ± 0.63 episodes, respectively (P = .09 at 3 months; P = .016 at 1 year). Among type 3R ARE, the CsA group showed 0.11 ± 0.32 and 0.13 ± 0.34 episodes, whereas the FK group experienced 0.05 ± 0.23 and 0.05 ± 0.23 episodes at 3 months and 1 year, respectively (P = .44 at 3 months, P = .35 at 1 year). The freedom rate from 1R, 2R, and 3R ARE was therefore similar between the two groups (P = .76, P = .14, and P = .23, respectively). Induction with FK-RATG tended to reduce the number of type 2R and greater rejection episodes per patient at 1 year after transplantation compared to CsA-RATG.