title: Usefulness of Rabbit Anti-thymocyte Globulin in Patients With Giant Cell Myocarditis.
abstract: Giant cell myocarditis (GCM) is an aggressive inflammatory myocardial disease. Immunosuppression is an effective treatment for some cases. However, the duration of action of agents such as muromonab CD3 is short and others such as the calcineurin inhibitors may lead to renal failure. Here we describe the outcome of a novel approach to treatment using rabbit anti-thymocyte globulin (RATG). A retrospective analysis of 6 patients treated with RATG for GCM was performed. Diagnosis was confirmed by endomyocardial biopsy, and RATG was administered with a high dose of corticosteroids. None of the patients had cytokine release syndrome or leukopenia, and 5 had thrombocytopenia (2 of them severe). Only 1 had a serious bleeding event that occurred after implantation of mechanical circulatory support. None developed impaired renal function after the treatment. Five were successfully discharged home with an increase in global left ventricular ejection fraction of 29%. Four are currently alive without recurrent disease, 1 of them after heart transplantation, with a mean follow-up of 970 days (423 to 1,875 days), left ventricular ejection fraction of 53%, and all in current New York Heart Association Classification class ≤II. Only 1 case had GCM recurrence. There were 2 deaths: one because of intracranial bleeding after mechanical circulatory support implantation and the other caused by primary graft dysfunction. In conclusion, patients with GCM can be successfully immunosuppressed with RATG and corticosteroids, thereby avoiding renal impairment. Early thrombocytopenia is the main adverse event. Larger cohorts of patients are necessary to compare the different immunosuppressant strategies available for GCM in a randomized fashion.
authors.affiliation: Transplant and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom. Electronic address: A.SuarezBarrientos@rbht.nhs.uk.
authors.forename: Aida
authors.initials: A
authors.lastname: Suarez-Barrientos
authors.affiliation: Transplant and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom.
authors.forename: Joyce
authors.initials: J
authors.lastname: Wong
authors.affiliation: Transplant and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bell
authors.affiliation: Transplant and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom.
authors.forename: Haifa
authors.initials: H
authors.lastname: Lyster
authors.affiliation: Transplant and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom.
authors.forename: Georgios
authors.initials: G
authors.lastname: Karagiannis
authors.affiliation: Transplant and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom; Imperial College, Institute of Cardiovascular Medicine and Science, National Heart and Lung Institute, London, United Kingdom.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Banner
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D001706:Biopsy; D005500:Follow-Up Studies; D015726:Giant Cells / Q000473:pathology*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007165:Immunosuppression Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis / Q000188:drug therapy*; D009206:Myocardium / Q000473:pathology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D007155:Immunologic Factors; C512542:thymoglobulin