title: Role for immune monitoring to tailor induction prophylaxis in pediatric heart recipients.
abstract: rATG is used for HTx induction but is costly and associated with infection and PTLD.
  
  
  OBJECTIVE
  Tailoring rATG induction with CD3 monitoring results in less infection, reduced costs, and similar rejection. Retrospective review of HTx recipients receiving rATG induction. Control cases received "usual" rATG dosing (1.5 mg/kg/day typically × 5 days). Starting in October 2009, absolute CD3 monitoring (target <25 cells/mm(3) ) guided rATG dosing (study cases). Outcomes included first-year incidence of infection/rejection, direct costs of therapy, and incidence of PTLD/death. Study cases (n = 32) received fewer doses of rATG (median 4 vs. 5, p < 0.001) and less total rATG (median 3.2 vs. 7.4 mg/kg, p < 0.001) compared with controls (n = 17). There was no difference in incidence of infection, rejection, or patient survival during the first year post-HTx. There was one early death in both groups and one late case of PTLD in the control group. Drug savings were significant (median drug cost per patient $2718 vs. $4756, p < 0.001). CD3-tailored rATG induction in HTx recipients is associated with reduced drug costs and similar rates of rejection/infection. Longer follow-up will determine whether extended benefits are associated with this induction monitoring strategy.
authors.affiliation: Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Philip T
authors.initials: PT
authors.lastname: Thrush
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Gossett
authors.forename: John M
authors.initials: JM
authors.lastname: Costello
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Matthews
authors.forename: Reem
authors.initials: R
authors.lastname: Nubani
authors.forename: Hardik
authors.initials: H
authors.lastname: Bhagat
authors.forename: Carl L
authors.initials: CL
authors.lastname: Backer
authors.forename: Elfriede
authors.initials: E
authors.lastname: Pahl
mesh_terms: D000293:Adolescent; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D017252:CD3 Complex / Q000378:metabolism; D009202:Cardiomyopathies / Q000276:immunology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006333:Heart Failure / Q000276:immunology / Q000628:therapy*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000276:immunology / Q000628:therapy*; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015166:Monitoring, Immunologic / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum; D017252:CD3 Complex; D007166:Immunosuppressive Agents
keywords: antithymocyte globulin; heart transplant; induction immunosuppression; pediatric