Thymoglobuline use in pediatric heart transplantation.
The literature has few data regarding the use of polyclonal anti-thymocyte globulin in pediatric cardiac transplantation. We describe our single-center, retrospective study of the use of Thymoglobuline in a pediatric population. We included in the study 31 consecutive heart transplant recipients (mean age, 7.8 years; median age, 9 years; range, 4 months-17 years), who all survived surgery. To induce immunosuppression, all patients received Thymoglobuline therapy at age-dependent doses (1-1.5 mg/kg/day between 0 and 1 year; 1.5-2 mg/kg/day from 1 year to 8 years; and 2.5 mg/kg/day >8 years). Duration of treatment was 1 to 7 days. In patients <1 year, the total number of lymphocytes was maintained at >500/mm(3). Thirty of 31 patients are alive at the end of follow-up. During the first 3 months, 3 Grade 3A and 10 Grade 1A (Working Formulation grading system) rejection episodes occurred. All reversed after steroid treatment. Eleven viral infections, 2 bacterial infections, and 1 fungal infection occurred. Not all patients with infection were symptomatic but all responded successfully to treatment. One episode of post-transplantation lymphoproliferative disease regressed after decreasing immunosuppression therapy and after acyclovir therapy. At the end of follow-up, 19 patients are without steroids. Immunosuppression therapy with Thymoglobuline is safe in the pediatric age group if the number of lymphocytes is monitored strictly.
Department of Pediatric Cardiology and Cardiac Surgery, Transplant Unit, Bambino Gesù Pediatric Hospital, Rome, Italy. parisi@opbg.net
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F
Parisi
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Danesi
C
C
Squitieri
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Di Chiara
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Ravà
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Di Donato
D000293:Adolescent; D000961:Antilymphocyte Serum / Q000276:immunology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000276:immunology / Q000627:therapeutic use*; D007223:Infant; D018655:Lymphocyte Count; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology*
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents