Thymoglobuline use in pediatric heart transplantation

Thymoglobulin Versus ATGAM Induction Therapy in Pediatric Kidney Transplant Recipients: A Single-Center Report

“…Brennan et al reported a 10% incidence of CMV at 6 months in adults receiving Thymoglobulin versus 33% in adults receiving AT-GAM (13). In the Parisi et al (16) study, the incidence of CMV was 13%, an incidence similar to ours.…”

“…In the Brennan et al (13) study, PTLD developed during follow-up in two (4%) of the adults who received ATGAM and none of the adults who received Thymoglobulin induction (15). Our 6% incidence in Thymoglobulin recipients was higher than the 3% reported by Parisi et al (16) and Filippo et al (17) in their pediatric heart Tx patients given Thymoglobulin induction and similar maintenance immunosuppression (18). The duration of Thymoglobulin administration was shorter in the heart Tx patients (mean 5; range, 1-7 days) than in ours (mean, 10; range, 6 -15 days), and this may have played a role in their reduced incidence of EBV-associated PTLD or lymphoma.…”

Postoperative Care of the Transplanted Patient

“…After their initial intent to induce “immune tolerance” failed, practical application of these drugs evolved into strategies to reduce early rejection, which was associated with improved peri-operative survival [77-81]. More recently, induction therapy has been used to delay the initiation of nephrotoxic calcineuin inhibitors and to achieve steroid avoidance [81-83].…”

“…More recently, induction therapy has been used to delay the initiation of nephrotoxic calcineuin inhibitors and to achieve steroid avoidance [81-83]. Despite its success in achieving these goals, the universal use of induction therapy was nonetheless limited due to mixed reports that it may have increased the risk for infection and post-transplant lymphoproliferative disease (PTLD).…”

“…Injection of the polyclonal sera into humans leads to antibodies coating recipient immune cells, which results in rapid depletion of recipient T-lymphocytes via opsinization, phagocytic, and natural killer cell mechanisms [22, 94]. Individual transplant physicians dose these agents to target total lymphocyte counts of 0.1-0.3 (X10 3 /mm 3 ) which appears efficacious without significantly increasing the risk of opportunistic infections [79, 81, 94]. Direct comparisons of the horse- and rabbit-derived preparations showed that the rabbit preparation more potently decreased circulating lymphocyte counts without a change in safety profile [95].…”