pubmed.ncbi.nlm.nih.gov

Thymoglobulin induction in heart transplantation: patient selection and implications for maintenance immunosuppression - PubMed

Review

Thymoglobulin induction in heart transplantation: patient selection and implications for maintenance immunosuppression

Andreas Zuckermann et al. Transpl Int. 2015 Mar.

Abstract

Clinical data relating to rabbit antithymocyte globulin (rATG) induction in heart transplantation are far less extensive than for other immunosuppressants, or indeed for rATG in other indications. This was highlighted by the low grade of evidence and the lack of detailed recommendations for prescribing rATG in the International Society for Heart and Lung Transplantation (ISHLT) guidelines. The heart transplant population includes an increasing frequency of patients on mechanical circulatory support (MCS), often with ongoing infection and/or presensitization, who are at high immunological risk but also vulnerable to infectious complications. The number of patients with renal impairment is also growing due to lengthening waiting times, intensifying the need for strategies that minimize calcineurin inhibitor (CNI) toxicity. Additionally, the importance of donor-specific antibodies (DSA) in predicting graft failure is influencing immunosuppressive regimens. In light of these developments, and in view of the lack of evidence-based prescribing criteria, experts from Germany, Austria, and Switzerland convened to identify indications for rATG induction in heart transplantation and to develop an algorithm for its use based on patient characteristics.

Keywords: Thymoglobulin; antithymocyte globulin; heart transplantation; rabbit antithymocyte globulin.

© 2014 The Authors Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT.

PubMed Disclaimer

Figures

Figure 1
Figure 1

Suggested algorithm for use of rATG induction in heart transplant patients (a) without mechanical circulatory support (MCS) or (b) with MCS. CNI, calcineurin inhibitor; HTx, heart transplantation; rATG, rabbit antithymocyte globulin. (a) 1High immunological risk (e.g. pre-transplant DSA, >4 HLA mismatches, black); post-puertum females; older age (>60–65 years); younger age (e.g. <35 years); children (e.g. <10 years); postoperative bleeding; history of malignancy. 224-h urine output, estimated GFR, protein/creatinine ratio; define cause of renal dysfunction. 3Estimated GFR ≥60 ml/min/1.73 m2 and protein:creatinine ≤0.3 in 24-h urine output analysis. (b) 1Driveline orificium; mediastinitis; positive blood culture; temperature >38.5 °C (F). 224-h urine output, estimated GFR protein/creatinine ratio; define cause of renal dysfunction. 3Estimated GFR ≥60 ml/min/1.73 m2 and protein:creatinine ≤0.3 in 24-h urine output analysis.

Similar articles

Cited by

References

    1. Organ Procurement and Transplant Network (OPTN) Annual Report 2012 http://srtr.transplant.hrsa.gov/annual_reports/2012 Accessed 11 June 2014.
    1. Lund LH, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Official Adult Heart Transplant Report–2013; focus theme: age. J Heart Lung Transplant. 2013;32:951. - PubMed
    1. Dipchand AI, Kirk R, Edwards LB, et al. The Registry of the International Society for Heart and Lung Transplantation: Sixteenth Official Pediatric Heart Transplantation Report – 2013; focus theme: age. J Heart Lung Transplant. 2013;32:979. - PubMed
    1. Costanzo MR, Dipchand A, Starling R, et al. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2010;29:914. - PubMed
    1. Gaber AO, Monaco AP, Russell JA, Lebranchu Y, Mohty M. Rabbit antithymocyte globulin (Thymoglobulin): 25 years and new frontiers in solid organ transplantation and haematology. Drugs. 2010;70:691. - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources