Prophylactic use of rabbit ATG vs horse ALG in heart‐transplanted patients under Sandimmun (CyA) therapy: Clinical and immunological effects

To identify whether prophylactic use of ATG is advantageous when compared with ALG in heart‐transplanted patients, a retrospective analysis of clinical and laboratory results was performed. Sixteen patients who received prophylactic rabbit ATG were compared with 36 receiving prophylactic horse ALG. Postoperative monitoring included endomyocardial biopsy, infection surveillance and peripheral lymphocyte identification with a panel of monoclonal antibodies. The ATG‐treated group, when compared with ALG‐treated, showed a marked suppression of peripheral lymphocyte count. Moreover, patients on ATG therapy, when compared with those receiving ALG, showed a statistical and prolonged (up to 30 days) decrease of CD2, CD3, CD4, CD8, CD20, CD25 and T‐5.9 (a CD4 subpopulation) positive cells. The incidence of rejection was lower in the first 3 months in ATG‐treated group and the overall incidence of infection was also significantly decreased. Thus, our results indicate that the use of prophylactic ATG is beneficial in heart‐transplanted patients since it may reduce rejection episodes without increasing the infection rate, despite the greater immunosuppression.