Acute hypersensitivity reaction on re‐exposure to basiliximab in an infant undergoing heart transplantation

Abstract

after the administering of insulin, unlike the glucose response, which requires 30-60 min. The marked resistance of the glycemic metabolism to insulin makes the coadministering of glucose unnecessary and it is better to monitor glycemia at 30-min intervals (4). Here, the greater need for glucose after reperfusion, even with good signs of the functioning of the graft was attributed to the longer plasma half-life of the insulin because of CRI.TEG measures the viscoelastic and mechanical properties of the developing clot. TEG allows a differential diagnosis of the coagulopathy and separation of surgical and non-surgical bleeding. It allows in vitro tests, such as therapeutic trials, but is unable to identify the specific factor in deficiency (5). During LT, heparinoids may appear after reperfusion of the graft and normally exhibit a self-limited behavior because of their rapid elimination. The inclusion of protamine in the TEG examination removes the heparin-like effect from the parameters of the sample tested, serving as a therapeutic trial (6). The presence of heparinoids was attributed to its longer elimination half-life associated to renal insufficiency. Protamine was administered to counteract the heparinlike action of the heparinoids, with a clinical improvement in bleeding. The aim was not the normalization of coagulation, but to avoid bleeding while the cause (heparinoids) was eliminated by the organism. With TEG, the infusion of blood products was guided, avoiding hypervolemia, trombosis of the anastomoses and the exposition of the patient to all risks associated to transfusions.In our case, a meticulous anesthesia technique, considering all the particularities of the patient, resulted in a successful transplant with no need for postoperative blood transfusions, re-operation because of bleeding or vascular thrombosis or urgent hemodialysis due to hydroelectrolytic disorders or hypervolemia.Fa bi ano S oa re s Ca rne iro * † Cris ti ano Hiroshi H o ri guthi * 49: 89-95.6 Coakley M, Reddy K, Mackie I et al. Transfusion triggers in orthotopic liver transplantation: A comparison of the thromboelastometry analyzer, the thromboelastogram, and conventional coagulation tests.SIR IR-We would like to report a case of a severe hypersensitivity reaction to basiliximab in a 7-month-old female infant, who presented for heart transplantation at our institution. She had been diagnosed with dilated cardiomyopathy (Fractional shortening = 6.7%) at 7 weeks of age. This was her second presentation for cardiac transplant; she had been scheduled for cardiac transplant 2 months previously but the procedure had been cancelled because of donor complications. She had received basiliximab as part of her induction immunosupression on the first presentation, immediately prior to cancellation of the procedure. On this occasion, induction of anesthesia with ketamine 1 mgAEkg )1 and fentanyl 3 lgAEkg )1 was uneventful. A nasotracheal tube was inserted after pancuronium 0.2 mgAEkg )1 . Arterial and central venous access was then secured wh...

Pre-implantation Basiliximab Reduces Incidence of Early Acute Rejection in Pediatric Heart Transplantation

“…We had 1 case of severe anaphylaxis in a 14-monthold child given basiliximab previously at an aborted transplant-an experience reported previously 21 and common to other findings in solid-organ transplantation. 22 This reinforces the importance of delaying basiliximab until it is certain that the donor organ is suitable to avoid the risk of sensitization and anaphylaxis at subsequent transplant.…”

Complete Steroid Avoidance Is Effective and Safe in Children With Renal Transplants: A Multicenter Randomized Trial With Three-Year Follow-Up

“…The low infection and malignancy rates are particularly important as there was a double total dose of daclizumab administered for 4 months longer in the SF than the steroid-based protocol, with equivalent dosing for tacrolimus and MMF in the two treatment arms. Furthermore, given some recent concerns of hypersensitivity with chimeric monoclonal interleukin 2 receptor antibody (basiliximab) infusions (32;33), it is important to note that there were no infusion-related adverse events with the fully humanized daclizumab in either treatment arm. The results of the current study can however not be generalized, and as daclizumab has been withdrawn from the market, it will be necessary to separately evaluate the safety and efficacy of basiliximab for induction in steroid-free immunosuppressive regimens in pediatric kidney transplantation.…”

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“…However, some case studies reported anaphylactic reactions after exposure to basiliximab. [9][10][11] These reactions were reported both on initial exposure to basiliximab and on reexposure. 11 According to the Novartis product prescribing information, other acute hypersensitivity reactions have been reported in patients treated with basiliximab.…”