Antithymocyte globulin therapy in chronic lung allograft dysfunction
IntroductionLung transplantation has seen strides in survival over the past few decades, though long-term survival remains poor. Chronic lung allograft dysfunction (CLAD) is a leading cause of graft failure and mortality beyond the first year. Anti-thymocyte globulin (ATG) is commonly used for treat...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-07-01
|
| Series: | Frontiers in Transplantation |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/frtra.2025.1607678/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849426924617596928 |
|---|---|
| author | Akhilesh Ajay Padhye Danielle Guffey Andres Leon-Pena Justin Segraves Ramiro Fernandez Gabriel Loor Puneet Garcha Tianshi David Wu Gloria Li |
| author_facet | Akhilesh Ajay Padhye Danielle Guffey Andres Leon-Pena Justin Segraves Ramiro Fernandez Gabriel Loor Puneet Garcha Tianshi David Wu Gloria Li |
| author_sort | Akhilesh Ajay Padhye |
| collection | DOAJ |
| description | IntroductionLung transplantation has seen strides in survival over the past few decades, though long-term survival remains poor. Chronic lung allograft dysfunction (CLAD) is a leading cause of graft failure and mortality beyond the first year. Anti-thymocyte globulin (ATG) is commonly used for treating refractory CLAD, though its efficacy remains uncertain.MethodsThis retrospective study evaluated the impact of ATG on lung function decline and mortality among lung transplant recipients diagnosed with CLAD, defined as a persistent >20% decline in forced expiratory volume (FEV1) from baseline. Patients treated with ATG were compared to those who did not receive ATG, using mixed effects modeling for FEV1 decline and Fine-Gray competing risk modeling for mortality.ResultsOf the 124 patients with CLAD, 55 (44%) received ATG. Administration was not associated with a significant change in FEV1 decline when compared to rate of decline prior to ATG administration [−0.0881 L/year, 95% CI (−0.21, 0.034)] or compared to non-ATG recipients [0.0599 L/year, 95% CI (−0.057, 0.18)]. However, ATG was associated with a lower hazard of all-cause mortality [subhazard ratio 0.66, 95% CI (0.39-1.14)].DiscussionWhile ATG improved survival, it did not alter lung function decline, affirming the need for prospective randomized studies. |
| format | Article |
| id | doaj-art-1938f05536794d3f9b20bb40e0bfdecb |
| institution | Kabale University |
| issn | 2813-2440 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Transplantation |
| spelling | doaj-art-1938f05536794d3f9b20bb40e0bfdecb2025-08-20T03:29:11ZengFrontiers Media S.A.Frontiers in Transplantation2813-24402025-07-01410.3389/frtra.2025.16076781607678Antithymocyte globulin therapy in chronic lung allograft dysfunctionAkhilesh Ajay Padhye0Danielle Guffey1Andres Leon-Pena2Justin Segraves3Ramiro Fernandez4Gabriel Loor5Puneet Garcha6Tianshi David Wu7Gloria Li8Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, United StatesInstitute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United StatesSection of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, United StatesSection of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, United StatesMichael E. DeBakey Department of Surgery, Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, TX, United StatesMichael E. DeBakey Department of Surgery, Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, TX, United StatesSection of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, United StatesSection of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, United StatesSection of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, United StatesIntroductionLung transplantation has seen strides in survival over the past few decades, though long-term survival remains poor. Chronic lung allograft dysfunction (CLAD) is a leading cause of graft failure and mortality beyond the first year. Anti-thymocyte globulin (ATG) is commonly used for treating refractory CLAD, though its efficacy remains uncertain.MethodsThis retrospective study evaluated the impact of ATG on lung function decline and mortality among lung transplant recipients diagnosed with CLAD, defined as a persistent >20% decline in forced expiratory volume (FEV1) from baseline. Patients treated with ATG were compared to those who did not receive ATG, using mixed effects modeling for FEV1 decline and Fine-Gray competing risk modeling for mortality.ResultsOf the 124 patients with CLAD, 55 (44%) received ATG. Administration was not associated with a significant change in FEV1 decline when compared to rate of decline prior to ATG administration [−0.0881 L/year, 95% CI (−0.21, 0.034)] or compared to non-ATG recipients [0.0599 L/year, 95% CI (−0.057, 0.18)]. However, ATG was associated with a lower hazard of all-cause mortality [subhazard ratio 0.66, 95% CI (0.39-1.14)].DiscussionWhile ATG improved survival, it did not alter lung function decline, affirming the need for prospective randomized studies.https://www.frontiersin.org/articles/10.3389/frtra.2025.1607678/fullchronic lung allograft dysfunctionanti-thymocyte globulinlung functionFEV1CLADATG |
| spellingShingle | Akhilesh Ajay Padhye Danielle Guffey Andres Leon-Pena Justin Segraves Ramiro Fernandez Gabriel Loor Puneet Garcha Tianshi David Wu Gloria Li Antithymocyte globulin therapy in chronic lung allograft dysfunction Frontiers in Transplantation chronic lung allograft dysfunction anti-thymocyte globulin lung function FEV1 CLAD ATG |
| title | Antithymocyte globulin therapy in chronic lung allograft dysfunction |
| title_full | Antithymocyte globulin therapy in chronic lung allograft dysfunction |
| title_fullStr | Antithymocyte globulin therapy in chronic lung allograft dysfunction |
| title_full_unstemmed | Antithymocyte globulin therapy in chronic lung allograft dysfunction |
| title_short | Antithymocyte globulin therapy in chronic lung allograft dysfunction |
| title_sort | antithymocyte globulin therapy in chronic lung allograft dysfunction |
| topic | chronic lung allograft dysfunction anti-thymocyte globulin lung function FEV1 CLAD ATG |
| url | https://www.frontiersin.org/articles/10.3389/frtra.2025.1607678/full |
| work_keys_str_mv | AT akhileshajaypadhye antithymocyteglobulintherapyinchroniclungallograftdysfunction AT danielleguffey antithymocyteglobulintherapyinchroniclungallograftdysfunction AT andresleonpena antithymocyteglobulintherapyinchroniclungallograftdysfunction AT justinsegraves antithymocyteglobulintherapyinchroniclungallograftdysfunction AT ramirofernandez antithymocyteglobulintherapyinchroniclungallograftdysfunction AT gabrielloor antithymocyteglobulintherapyinchroniclungallograftdysfunction AT puneetgarcha antithymocyteglobulintherapyinchroniclungallograftdysfunction AT tianshidavidwu antithymocyteglobulintherapyinchroniclungallograftdysfunction AT gloriali antithymocyteglobulintherapyinchroniclungallograftdysfunction |