Immunosuppression induction with daclizumab and antithymocyte globulin in cardiac transplantation: clinical experience with 8 cases.

Objective: To review the clinical experience of immunosuppression induction therapy to prevent acute rejection in 8 patients with cardiac transplant.

Methods: Between June, 2000 and May, 2002, 8 patients with end-stage dilated cardiomyopathy undergoing orthotopic cardiac transplantation received induction therapy with two-dose daclizumab (1.0 mg/kg), given intravenously within 12 h before cardiac-transplantation surgery and two weeks thereafter, and with an initial 5-day course of intravenous antithymocyte globulin (100 mg/d) following transplantation. Cyclosporine or tacrolimus, mycophenolate mofetil or azathioprine, and prednisolone were applied for immunosuppression maintenance.

Results: No death occurred during the follow-up. Routine endomyocardial biopsies in all cases performed in the early stage detected only mild rejection, and no acute allograft or renal dysfunction was found. Three patients developed opportunistic infection, and only one had late acute rejection in the 14th post-transplantation month.

Conclusions: Induction therapy with intravenous daclizumab and antithymocyte globulin is effective to prevent acute rejection and alleviate organ dysfunction in cardiac transplantation, but might increase the chance of infections.