The superiority of different induction
therapies after heart-lung and
lung transplantation is not clearly established; specifically, whether monoclonal (
OKT3) or polyclonal antibody induction
therapy provides any advantage. Between 1989 and 1991 we used induction
therapy with either
rabbit antithymocyte globulin (RATG) or
OKT3, given at random based on the availability of RATG. RATG was used in 25 patients (RATG group 1) and
OKT3 in 38 patients (
OKT3 group 1). Early results suggested a survival advantage with RATG. From 1992 until 1997 we used RATG induction
therapy in 108 patients (RATG group 2). This study analyzed longer-term survival,
infection, rejection, and obliterative
bronchiolitis (OB) rates for RATG group 1 and
OKT3 group 1 and assessed outcomes for RATG group 2. The 1-, 3-, and 5-year survival for RATG group 1 was 72 %, 72 %, and 52 % and for
OKT3 group 1 was 63 %, 49 %, and 34 % (P < 0.05). The 1- and 3-year survival for RATG group 2 was 84 % and 74 %. The 1-, 3-, and 5-year actuarial freedom rates from lung rejection for RATG group 1 were 38 %, 38 %, and 31 % and for
OKT3 group 1 were 21 %, 0 %, and 0 % (P < 0.01). The linearized rate (events/100 patient days) of all
infections at 3 months was 1.55 +/- 0.28 for RATG group 1 and 2.19 +/- 0.27 for
OKT3 group 1 (P = NS). The
infection rate for RATG group 2 was 1.60 +/- 0.13. The actuarial rates of freedom from OB at 1, 3, and 5 years for RATG group 1 were 84 %, 51 %, and 45 % and for
OKT3 group 1 were 77 %, 61 %, and 36 % (P = NS), while for RATG group 2 the rates were 97 % and 92 % at 1 and 3 years (P < 0.01 vs RATG group 1 and
OKT3 group 1). The use of RATG induction
therapy from 1989 through 1991 resulted in improved actuarial survival and less rejection, without increased
infection rates. The use of RATG since 1992 has continued to result in similar outcomes for survival,
infection, and rejection. The time to onset of OB has improved further in recent years. This may be a result of recent improvements in cytomegalovirus (CMV) prophylaxis.