The use of drotrecogin alfa (activated) in solid organ transplant patients: a case series

Abstract

DAA appears to be safe with appropriate monitoring. However, transplant recipients had a higher incidence of bleeding events leading to early discontinuation of DAA. Efficacy is difficult to assess without an appropriate control group for comparison.

The use of recombinant human activated protein C (drotrecogin alpha) in solid organ transplant recipients: case series and review of the literature

“…In contrast, the mortality in our series was 23.5%, less than what the APACHE II score predicted (56.9%), and in keeping with the mortality of the PROWESS (24.7%) and ENHANCE (25.3%) trials. Bleeding events in the Berkman et al (25) series (28%) were similar to our rate (17.7%), and higher than reported in either the ENHANCE or PROWESS trials. As mentioned previously, this higher rate of bleeding events is likely to be the result of 3 factors: the ‘real world’ experience with this drug that likely results in higher bleeding rates, the postoperative state of many of our patients, and potential baseline coagulation abnormalities.…”

“…To date, no randomized trial has evaluated the role of rhaPC in patients with SOTs. Several case reports and 3 case series have examined the use of rhaPC in SOT recipients with septic shock (see Table 5) (18–25). The initial case reports had extremely favorable outcomes, with only 1 death in the 14 patients reported (18–24).…”

“…The initial case reports had extremely favorable outcomes, with only 1 death in the 14 patients reported (18–24). A much larger series by Berkman et al (25) describes their institution's experience with rhaPC and SOT recipients. Their series included abdominal organ transplant recipients who developed septic shock.…”