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
New developments in immunosuppressive therapy for heart transplantation.
TL;DR: This article gives an overview of the immunosuppressive agents in current use, with a detailed review of emerging drugs with novel therapeutic targets.
Journal ArticleDOI
Combined Heart and Kidney Transplantation: A 23-Year Experience.
Mark M. Awad,Lawrence S.C. Czer,Fardad Esmailian,Stanley C. Jordan,M. De Robertis,James Mirocha,Jignesh Patel,David Chang,Michelle M. Kittleson,Danny Ramzy,Francisco A. Arabia,J. Chung,J.L. Cohen,Alfredo Trento,Jon A. Kobashigawa +14 more
TL;DR: The most recent cohort of combined heart and kidney transplant recipients had similar ICU and hospital lengths of stay and post-operative creatinine levels at peak, discharge, and 1 and 5 years and a similar number of patients on post-operation dialysis when compared with the initial cohort.
Journal ArticleDOI
Combined heart and kidney transplantation: what is the appropriate surgical sequence?
TL;DR: The staged surgical approach is suggested as the preferred method for transplant with the same long-term survival rate, low cellular rejection and antibody-mediated rejection rates when compared with heart transplant alone.
Journal ArticleDOI
Use of Ventricular Assist Device as Bridge to Simultaneous Heart and Kidney Transplantation in Patients with Cardiac and Renal Failure
R. Yanagida,Lawrence S.C. Czer,A. Ruzza,Ernst R. Schwarz,Sinan Simsir,Stanley C. Jordan,Alfredo Trento +6 more
TL;DR: Based on the initial experience, simultaneous HKT is a safe treatment option with excellent outcomes for patients with advanced heart failure and persistent renal dysfunction after VAD implantation.
Journal ArticleDOI
Is induction therapy still needed in heart transplantation
TL;DR: Induction therapy still has its place in the immunosuppressive armamentarium after cardiac transplantation, and new antibody generations and the selection of special patient groups demonstrate that induction therapy is effective and well tolerated in its use.
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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