Rabbit antithymocyte globulin as induction immunotherapy in pediatric heart transplantation

Filippo, Sylvie Di; Boissonnat, P.; Sassolas, F; Robin, Jacques; Ninet, J; Champsaur, G; Bozio, A

doi:10.1097/01.tp.0000045223.66828.fa

Cited by 43 publications

(39 citation statements)

References 15 publications

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“…The specific symptom of jaw pain and trismus which he experienced seems to be particularly common in serum sickness [5]. The diagnosis is further supported by detection of heterologous antibodies to rabbit IgG [3].…”

Section: Discussionmentioning

confidence: 96%

“…To our knowledge, this is the first case published in the literature of serum sickness in a heart transplantation patient receiving rabbit ATG after prior rabbit exposure, with a delayed presentation due to concurrent high-dose steroids. In the only series of heart transplantation patients receiving ATG that specifically mentioned observation for serum sickness, the incidence of this complication was zero [5]. The first reported case of serum sickness in a cardiac transplantation patient was recently published in the literature in December 2012 [1].…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Serum Sickness After Treatment With Rabbit Antithymocyte Globulin in a Heart Transplant Recipient With Previous Rabbit Exposure

Lyons

Castillo

Potter

et al. 2015

Transplantation Proceedings

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

Serum Sickness After Treatment With Rabbit Antithymocyte Globulin in a Heart Transplant Recipient With Previous Rabbit Exposure

Lyons

Castillo

Potter

et al. 2015

Transplantation Proceedings

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“…Administration of rATG is usually uneventful, the most common complication being hematological disorders (eg, thrombocytopenia and leukopenia) [13,14]. However, more serious complications have been reported, including serum sickness [15], acute respiratory distress syndrome [16], delayed cardiovascular compromise [17], and acute renal failure [18].…”

Section: Discussionmentioning

confidence: 99%

Severe anaphylactoid reaction to thymoglobulin in a pediatric renal transplant recipient

Sebeo

Ezziddin

Eisenkraft

2012

Journal of Clinical Anesthesia

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“…It is produced by immunizing rabbits with human thymocytes and is used both as an induction agent and as a treatment for steroid-refractory rejection and acute rejection with hemodynamic compromise [15].…”

Section: Rabbit Antithymocyte Globulinmentioning

confidence: 99%

“…& The main goals of induction therapy are to prevent or delay time to first acute rejection and to enable delay in administration of CNIs in the immediate postoperative period, reducing early renal dysfunction [14,15]. They also likely play a role in facilitating complete steroid avoidance regimens [10•].…”

Section: Treatment Induction Therapymentioning

confidence: 99%

Immunosuppression Therapy for Pediatric Heart Transplantation

Irving

Webber

2010

Curr Treat Options Cardio Med

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Outcomes following cardiac transplantation in childhood continue to improve. Advances in immunosuppressive therapy over the past two decades likely have contributed to this trend. The evolution in the management of immunosuppression in children has been based on clinical experience rather than on evidence-based medicine; indeed, there have been no pivotal randomized controlled trials of any form of immunosuppression in pediatric thoracic transplantation. Important trends in immunosuppressive therapy and transplant outcomes have been obtained from large transplant registries. Several trends have been identified since the last review of this topic in this journal. First, there is increased knowledge of the pharmacodynamics and pharmacokinetics of immunosuppressive drugs in children, with notable advances in the field of pharmacogenomics. These studies help explain individual variations in drug exposure, efficacy, and adverse events. They also help explain racial and ethnic variations in drug metabolism and efficacy. Second, there have been clear trends in the use of specific immunosuppressive medications. Use of induction therapy, especially polyclonal T cell-depleting antibody preparations, has increased significantly in recent years. The calcineurin inhibitor (CNI) tacrolimus is being used as the cornerstone of maintenance therapy in lieu of cyclosporine in more and more centers. Mounting evidence suggests that use of adjunctive agents (notably mycophenolate mofetil [MMF]) may improve outcomes, including survival, suggesting that monotherapy with CNIs is not the ideal maintenance therapy. Despite its increased cost, MMF has largely replaced azathioprine as the adjunctive agent of choice. Inhibitors of the mammalian target of rapamycin (i.e., sirolimus and everolimus) have not yet assumed a major place as adjunctive agents, as their safety and efficacy have not been well established in children. With the improvements in immunosuppressive therapy, the justification for routine corticosteroid use is far from clear, and many centers have shown excellent outcomes with complete steroid avoidance. Third, there is increasing interest in the importance of anti-HLA antibodies as important risk factors for adverse graft and patient outcomes. This is generating intense interest in treatments that target B cells and plasma cells. Finally, there is increasing realization that the "one size fits all" approach to immunosuppressive therapy is an obsolete concept and that the ultimate goal is to tailor immunosuppressive therapy to the needs of the individual patient. The development of reliable biomarkers of the patient's immune response to the allograft will be essential for optimal individualized immunosuppressive management.

show abstract

Rabbit antithymocyte globulin as induction immunotherapy in pediatric heart transplantation

Cited by 43 publications

References 15 publications

Serum Sickness After Treatment With Rabbit Antithymocyte Globulin in a Heart Transplant Recipient With Previous Rabbit Exposure

Serum Sickness After Treatment With Rabbit Antithymocyte Globulin in a Heart Transplant Recipient With Previous Rabbit Exposure

Severe anaphylactoid reaction to thymoglobulin in a pediatric renal transplant recipient

Immunosuppression Therapy for Pediatric Heart Transplantation

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