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15 May 2018 : Review article  

A Review of Induction with Rabbit Antithymocyte Globulin in Pediatric Heart Transplant Recipients

Martin Schweiger1EF*, Andreas Zuckermann2EF, Andres Beiras-Fernandez3EF, Michael Berchtolld-Herz4EF, Udo Boeken5EF, Jens Garbade6EF, Stephan Hirt7EF, Manfred Richter8EF, Arjang Ruhpawar9EF, Jan Dieter Schmitto10EF, Felix Schönrath11EF, Rene Schramm12EF, Uwe Schulz13EF, Markus J. Wilhelm14EF, Markus J. Barten15EF

DOI: 10.12659/AOT.908243

Ann Transplant 2018; 23:322-333

Abstract

Pediatric heart transplantation (pHTx) represents only a small proportion of cardiac transplants. Due to these low numbers, clinical data relating to induction therapy in this special population are far less extensive than for adults. Induction is used more widely in pHTx than in adults, mainly because of early steroid withdrawal or complete steroid avoidance. Antithymocyte globulin (ATG) is the most frequent choice for induction in pHTx, and rabbit antithymocyte globulin (rATG, Thymoglobulin®) (Sanofi Genzyme) is the most widely-used ATG preparation. In the absence of large, prospective, blinded trials, we aimed to review the current literature and databases for evidence regarding the use, complications, and dosages of rATG. Analyses from registry databases suggest that, overall, ATG preparations are associated with improved graft survival compared to interleukin-2 receptor antagonists. Advantages for the use of rATG have been shown in low-risk patients given tacrolimus and mycophenolate mofetil in a steroid-free regimen, in sensitized patients with pre-formed alloantibodies and/or a positive donor-specific crossmatch, and in ABO-incompatible pHTx. Registry and clinical data have indicated no increased risk of infection or post-transplant lymphoproliferative disorder in children given rATG after pHTx. A total rATG dose in the range 3.5–7.5 mg/kg is advisable.

Keywords: Antilymphocyte Serum, Heart Transplantation, Pediatrics

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358