Journal ArticleDOI
Induction Therapy With Thymoglobulin After Heart Transplantation: Impact of Therapy Duration on Lymphocyte Depletion and Recovery, Rejection, and Cytomegalovirus Infection Rates
Sorel Goland,Lawrence S.C. Czer,Bernice Coleman,Michele A. De Robertis,James Mirocha,Kaveh Zivari,Ernst R. Schwarz,Robert M. Kass,Alfredo Trento +8 more
TLDR
The 7-day treatment led to more efficient and prolonged lymphocyte depletion and significantly less rejection at 1 year, without an increase in cytomegalovirus infection rate.Abstract:
Background This retrospective single-center study compared lymphocyte depletion in 144 heart transplant recipients using 2 different induction protocols with Thymoglobulin (Genzyme Transplant, Cambridge, MA). Methods Thymoglobulin (1.5 mg/kg) was given to 105 patients for 7 days (Thymo7) and 39 patients for 5 days (Thymo5). Results Patient clinical characteristics were similar except that the Thymo7 group had a higher prevalence of women (33% vs 15%, p = 0.04), gender mismatch (35% vs 19%, p = 0.07), donor African American race (19% vs 2%, p = 0.008), older donor age (35 ± 13 vs 31 ± 12, p = 0.08), and higher pre-transplant creatinine (1.43 ± 0.67 vs 1.25 ± 0.48 mg/dl, p = 0.095). Seventy-five percent of the Thymo7 group reached target (absolute lymphocyte count ≤200) and 42% at 21 days ( p = 0.002). Thymo7 patients had significantly lower rejection rates (≥1B) within the first year (7% vs 22%, p = 0.02). No humoral rejection occurred. At 1 year, freedom from rejection was 93% in the Thymo7 group vs 80% in the Thymo5 group ( p = 0.007), and cytomegalovirus disease (9% and 5%, p = 0.5) and bacterial infection (26% vs 32%, p = 0.5) were similar. One-year actuarial survival was 92% ± 3% in the Thymo7 and 100% in the Thymo5 group ( p = 0.07), and at 3 years, 85 ± 4% and 90 ± 6%, respectively ( p = 0.4). Conclusions Both Thymoglobulin regimens were well tolerated. The 7-day treatment led to more efficient and prolonged lymphocyte depletion and significantly less rejection at 1 year, without an increase in cytomegalovirus infection rate.read more
Citations
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Journal ArticleDOI
Combined Heart and Kidney Transplantation: Clinical Experience in 100 Consecutive Patients.
M. Awad,Lawrence S.C. Czer,Dominic Emerson,Stanley C. Jordan,Michele A. De Robertis,James Mirocha,Evan P. Kransdorf,David Chang,Jignesh Patel,Michelle M. Kittleson,Danny Ramzy,J. Chung,J. Louis Cohen,Fardad Esmailian,Alfredo Trento,Jon A. Kobashigawa +15 more
TL;DR: HKTx is safe to perform in patients 60 years and older or younger than60 years and with or without dialysis dependence, with excellent outcomes and the degree of panel‐reactive antibody sensitization did not appear to affect survival after HKTx.
Journal ArticleDOI
Induction therapy in heart transplantation: where are we now?
TL;DR: Until the question of whether rATG is associated with increased risk of infection, routine prophylaxis is advisable, and IL‐2RA induction has an excellent safety profile.
Journal ArticleDOI
Bariatric Surgery in Severe Obesity and End-stage Heart Failure With Mechanical Circulatory Support as a Bridge to Successful Heart Transplantation: A Case Report
TL;DR: The concurrent use of mechanical circulatory support and bariatric surgery in a morbidly obese patient allowed the patient to lose weight and subsequently to qualify for placement on the heart transplant waiting list.
Journal ArticleDOI
Impact of Virtual Cross Match on Waiting Times for Heart Transplantation
R. Yanagida,Lawrence S.C. Czer,Nancy L. Reinsmoen,Kai Cao,Matthew Rafiei,Michele A. De Robertis,James Mirocha,Robert M. Kass,Jon A. Kobashigawa,Alfredo Trento +9 more
TL;DR: In sensitized heart transplant candidates, virtual cross match may shorten waiting time to heart transplantation without increasing subsequent occurrence of cellular rejection, antibody mediated rejection, and mortality after heart transplants.
Journal ArticleDOI
Heart transplantation in patients aged 70 years and older: a two-decade experience.
Daniel Daneshvar,Lawrence S.C. Czer,Anita Phan,Ernst R. Schwarz,M. De Robertis,James Mirocha,Matthew Rafiei,J.R. Pixton,Robert M. Kass,Alfredo Trento +9 more
TL;DR: Patients who are aged 70 years and older can undergo heart transplantation with similar morbidity and mortality when compared with younger recipients, and should not be excluded from transplant consideration based solely on an age criterion.
References
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Journal ArticleDOI
Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report
Gerhard Opelz,Bernd Döhler +1 more
TL;DR: The continuing risk for lymphoma with time post‐transplantation, the contribution of immunosuppression to increased risk, and continuing poor outcomes in patients with post-transplant lymphoma are highlighted.
Journal ArticleDOI
Rabbit antithymocyte globulin versus basiliximab in renal transplantation.
TL;DR: Among patients at high risk for acute rejection or delayed graft function who received a renal transplant from a deceased donor, induction therapy consisting of a 5-day course of antithymocyte globulin, as compared with basiliximab, reduced the incidence and severity of acute rejection but not the incidence of delayed graftfunction.
Journal ArticleDOI
Mechanisms of action of antithymocyte globulin : T-cell depletion and beyond
TL;DR: ATG provides multifaceted immunomodulation paving the way for future applications and suggesting that the use of ATG should be included in the immunosuppression therapeutic armamentarium to help reduce the incidence of organ rejection and GVHD.
Journal ArticleDOI
A Novel Mechanism of Action for Anti-Thymocyte Globulin: Induction of CD4+CD25+Foxp3+ Regulatory T Cells
TL;DR: It is reported for the first time that ATG but not anti-CD52 mAb (alemtuzumab) or the IL-2R antagonists causes rapid and sustained expansion of CD4+CD25+ T cells when cultured with human peripheral blood lymphocytes.
Journal ArticleDOI
Induction therapy with basiliximab allows delayed initiation of cyclosporine and preserves renal function after cardiac transplantation.
Paul B. Rosenberg,Paul B. Rosenberg,Ank E. Vriesendorp,Mark H. Drazner,Mark H. Drazner,Daniel L. Dries,Patricia A. Kaiser,Linda S. Hynan,J. Michael DiMaio,J. Michael DiMaio,Dan M. Meyer,Dan M. Meyer,W. Steves Ring,W. Steves Ring,Clyde W. Yancy,Clyde W. Yancy +15 more
TL;DR: Basiximab induction therapy allows delayed initiation of cyclosporine after cardiac transplantation without an increase in rejection and reduces the risk of post-operative renal dysfunction.
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