Repeated Daclizumab Administration to Delay the Introduction of Calcineurin Inhibitors in Heart Transplant Patients With Postoperative Renal Dysfunction

Lázaro, Ignacio J. Sánchez; Bonet, Luis Almenar; Dolz, Luis Martínez; Fuentes, Francisco Buendía; Manchón, Josep Navarro; Ramón-Llin, Jaime Agüero; Sánchez, José Luis Vicente; Sanz, Antonio Salvador

doi:10.1016/j.rec.2010.05.001

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…rATG induction can provide immunosuppressive cover until CNI therapy is introduced. Retrospective studies of heart transplant patients receiving rATG have reported varying times for delay of CNI introduction , ranging from 3 days to as long as 18 or 20 days . In 2004, Cantarovich and colleagues published retrospective data demonstrating that rATG induction with delayed CNI (started only when serum creatinine fell below 150 μmol/l) provided comparable efficacy to rATG with immediate CNI .…”

Section: Impaired Renal Functionmentioning

confidence: 99%

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

et al. 2014

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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.

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Section: Impaired Renal Functionmentioning

confidence: 99%

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

et al. 2014

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“…This strategy is used frequently in heart transplant recipients, although the evidence base is currently restricted to retrospective studies (Table ). The time to introduction of CNI therapy has varied between studies, from as soon as day 4 or 5 after transplant, up to a mean of day 12 or even as long as 18 or 29 days in some patients .…”

Section: Induction Therapy and Delayed Cni Therapymentioning

confidence: 99%

Induction therapy in heart transplantation: where are we now?

et al. 2013

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Summary Although induction therapy has been used in heart transplantation for many years, its role has not been fully elucidated. Early safety concerns relating to OKT3 or intensive lymphocyte‐depleting regimens have largely been addressed by modern induction protocols using rabbit antithymocyte globulin (rATG [Thymoglobuline® or ATG‐Fresenius]) and interleukin‐2 receptor antagonist (IL‐2RA) agents, but although the number of randomized controlled studies has expanded there are still gaps in the evidence base. Rejection prophylaxis may be somewhat more effective with rATG than IL‐2RA agents, but this has not been proven conclusively. Administration of induction therapy to support delayed introduction of calcineurin inhibitors in patients at risk of renal dysfunction is relatively well documented and widely used. Increasingly, it is recognized that sensitized patients and individuals with primary graft function are suitable candidates for induction therapy, and the possibility that rATG may inhibit cardiac allograft vasculopathy is also of considerable interest. Until the question of whether rATG is associated with increased risk of infection, routine prophylaxis is advisable. IL‐2RA induction has an excellent safety profile. Dosing rATG according to lymphocyte count reduces cumulative dose without compromising efficacy. Further controlled trials are required to determine when and how to deploy induction most effectively following heart transplantation.

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