Outcomes Following Antithymocyte Globulin (ATGAM) for Chronic Lung Allograft Dysfunction Post Lung Transplantation

Abstract

Purpose Chronic lung allograft dysfunction (CLAD) is the major factor limiting survival post lung transplantation (LTx) and has limited effective therapeutic options. We report our 12-yr experience of using Antithymocyte Globulin (ATGAM) as second line therapy for CLAD. Methods Clinical parameters and lung function data was collected on all LTx patients receiving ATGAM from January 2006. CLAD phenotype was determined by spirometry and radiology. Rate of FEV1 decline (mls/day) was calculated prior to and after ATGAM. A clinical response to ATGAM was defined by the rate of FEV1 improving 20% or by an absolute improvement in baseline FEV1. Results 76 patients (mean age 48 yrs, female 57%) received ATGAM for CLAD of whom 21 patients received ATGAM twice, equine ATGAM followed by rabbit ATGAM, with 97 ATGAM courses being administered. Following ATGAM, there was a significant drop in the daily decline of FEV1 (5.7 mls/day vs 3.1 mls/day, p Conclusion Our experience highlights the biggest single-center experience of ATGAM to date. ATGAM reduces the rate of decline in lung function. Further studies are warranted to determine clinical factors that predict a response to ATGAM therapy.