Effect of Daclizumab Induction Therapy on the Development of Cardiac Transplant Vasculopathy

Use of Daclizumab in de novo cardiac transplant recipients significantly decreases the incidence and severity of acute allograft rejection in the first 3 months post transplant. We investigated if the incidence of graft vasculopathy is decreased at 1 year post transplant in patients receiving dacluzimab. 57 de-novo, non-sensitized patients transplanted from 11/98 to 10/1/00 who survived their first year post transplant were studied. 29 patients received daclizumab and 28 patients did not. Angiograms were scored using a semi-quantitative scale. Multivarianble analysis using logistic regression was then performed including donor and recipient age, etiology of heart failure, ischemic time, HLA matching, presence of HLA antibodies, total number of allograft rejections (> ISHLTgrade 1B), number of grade 3A rejections, and use of daclizumab to determine predictors of graft atherosclerosis. Age, etiology of heart failure, ischemic time, total number of rejection episodes and HLA matching were not different between the daclizumab and control groups (p=NS for all). Donor age was significantly younger in the Daclizumab group (25±10 vs 35±9 yrs;p <.005). The total number of 3A rejections tended to be less in the daclizumab group (5 vs 10). Multivariable analysis revealed that use of daclizumab and ischemic time (both p<0.05) to be significant predictors of future graft atherosclerosis. In conclusion, use of induction therapy with daclizumab may decrease development of transplant graft atherosclerosis.