Continuous infusion of thymoglobulin for induction therapy in pediatric heart transplant recipients; experience and outcomes with a novel strategy for administration

Minimal data exist on the perioperative use of TG for induction in pediatric HTx recipients. We report our experience using continuous infusion of TG on (i) perioperative adverse events, (ii) rejection, (iii) CAV, and (iv) PTLD. TG was infused via peripheral intravenous intra- and perioperatively as a continuous infusion (24 h/day). Starting dose was 1.5 mg/kg/day titrated to achieve target lymphocyte count of 0.1-0.3 x 10(9)/L. Fifty-five patients received TG; mean age at HTx was 4.4 yr (1 day-17.8 yr). The mean duration of TG was three and a half days (2-7 days). Median platelet count during TG infusion was 95 x 10(9)/L (28-228). Five patients had TG stopped for low platelets (at 4-6 days post-HTx) - all started maintenance immunosuppression. There was no perioperative mortality due to infection. Mean follow-up of 46 survivors was 2.3 yr (0.6-5.8 yr). Fifty-one percent had >= ISHLT 2R rejection at a median time of 33 days post-HTx (7 days-2 yr). One patient developed PTLD 1.4 yr post-HTx; three patients developed mild-moderate CAV. TG as a continuous infusion appears to have a good safety profile. Though mild thrombocytopenia was prevalent, there was no bleeding attributable solely to TG. Whether early depletion of T-cell function will translate into long-term benefits remains to be determined.