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Role for immune monitoring to tailor induction prophylaxis in pediatric heart recipients
Author(s) -
Thrush Philip T.,
Gossett Jeffrey G.,
Costello John M.,
Matthews Kathleen L.,
Nubani Reem,
Bhagat Hardik,
Backer Carl L.,
Pahl Elfriede
Publication year - 2014
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12193
Subject(s) - medicine , incidence (geometry) , dosing , induction therapy , heart transplantation , surgery , transplantation , chemotherapy , physics , optics
Abstract r ATG is used for HT x induction but is costly and associated with infection and PTLD . Hypothesis: Tailoring r ATG induction with CD 3 monitoring results in less infection, reduced costs, and similar rejection. Retrospective review of HT x recipients receiving r ATG induction. Control cases received “usual” r ATG dosing (1.5 mg/kg/day typically × 5 days). Starting in O ctober 2009, absolute CD 3 monitoring (target <25 cells/mm 3 ) guided r ATG 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 r ATG (median 4 vs. 5, p < 0.001) and less total r ATG (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‐ HT x. 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 r ATG induction in HT x 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.