A Proposal for Early Dosing Regimens in Heart Transplant Patients Receiving Thymoglobulin and Calcineurin Inhibition

被引:10
作者
Barten, Markus J. [1 ]
Schulz, Uwe [2 ]
Beiras-Fernandez, Andres [3 ]
Berchtold-Herz, Michael [4 ]
Boeken, Udo [5 ]
Garbade, Jens [6 ]
Hirt, Stephan [7 ]
Richter, Manfred [8 ]
Ruhpawar, Arjang [9 ]
Schmitto, Jan Dieter [10 ]
Schoenrath, Felix [11 ]
Schramm, Rene [12 ]
Schweiger, Martin [13 ]
Wilhelm, Markus [14 ]
Zuckermann, Andreas [15 ]
机构
[1] Univ Hosp Hamburg Eppendorf, Univ Heart Ctr, Martinistr 52, D-20246 Hamburg, Germany
[2] Ruhr Univ Bochum, Heart & Diabet Ctr NRW, Clin Thorac & Cardiovasc Surg, Bad Oeynhausen, Germany
[3] Goethe Univ Frankfurt, Dept Cardiac & Thorac Surg, Frankfurt, Germany
[4] Heart Ctr Freiburg Univ, Dept Cardiovasc Surg, Freiburg, Germany
[5] Heinrich Heine Univ, Dept Cardiovasc Surg, Dusseldorf, Germany
[6] Univ Hosp Leipzig, Heart Ctr Leipzig, Dept Cardiac Surg, Leipzig, Germany
[7] Univ Regensburg, Dept Cardiac & Thorac Surg, Regensburg, Germany
[8] Kerckkoff Clin, Bad Nauheim, Germany
[9] Heidelberg Univ, Cardiac Surg Clin, Heidelberg, Germany
[10] Hannover Med Sch, Dept Cardiac Thorac Transplantat & Vasc Surg, Hannover, Germany
[11] German Heart Inst, Dept Cardiac Thorac & Vasc Surg, Berlin, Germany
[12] Ludwig Maximilians Univ Munchen, Clin Cardiac Surg, Munich, Germany
[13] Childrens Hosp, Dept Cardiac Surg, Zurich, Switzerland
[14] Univ Hosp Zurich, Clin Cardiovasc Surg, Zurich, Switzerland
[15] Med Univ Vienna, Dept Cardiac Surg, Vienna, Austria
来源
TRANSPLANTATION DIRECT | 2016年 / 2卷 / 06期
关键词
D O I
10.1097/TXD.0000000000000594
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
There is currently no consensus regarding the dose or duration of rabbit antithymocyte globulin (rATG) induction in different types of heart transplant patients, or the timing and intensity of initial calcineurin inhibitor (CNI) therapy in rATG-treated individuals. Based on limited data and personal experience, the authors propose an approach to rATG dosing and initial CNI administration. Usually rATG is initiated immediately after exclusion of primary graft failure, although intraoperative initiation may be appropriate in specific cases. A total rATG dose of 4.5 to 7.5 mg/kg is advisable, tailored within that range according to immunologic risk and adjusted according to immune monitoring. Lower doses (eg, 3.0 mg/kg) of rATG can be used in patients at low immunological risk, or 1.5 to 2.5mg/kg for patients with infection onmechanical circulatory support. The timing of CNI introduction is dictated by renal recovery, varying between day 3 and day 0 after heart transplantation, and the initial target exposure is influenced by immunological risk and presence of infection. Rabbit antithymocyte globulin and CNI dosing should not overlap except in high-risk cases. There is a clear need for more studies to define the optimal dosing regimens for rATG and early CNI exposure according to risk profile in heart transplantation.
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页数:11
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