Deep vein thrombosis during rabbit antithymocyte globulin administration

Area of Science:

• Transplantation Immunology
• Vascular Thrombosis

Background:

• Rabbit antithymocyte globulin (RATG) is a common immunosuppressant in transplantation.
• Heparin coadministration with RATG is common but lacks evidence, potentially complicating thrombocytopenia evaluation.
• The practice of discontinuing heparin in RATG infusions prompted an investigation into deep vein thrombosis (DVT) risk factors.

Purpose of the Study:

• To identify factors associated with deep vein thrombosis (DVT) in kidney and kidney-pancreas transplant recipients receiving rabbit antithymocyte globulin (RATG).

Main Methods:

• Retrospective chart review of patients receiving RATG between January 2000 and April 2004.
• Inclusion criteria focused on confirmed DVT diagnoses related to RATG therapy.
• Analysis of patient characteristics, infusion methods, and associated medications.

Main Results:

• Five patients developed DVT related to RATG therapy.
• All DVT cases occurred in patients who received RATG peripherally, experienced infusion-related reactions, and did not receive heparin.
• Deep vein thrombosis (DVT) often occurred near the infusion site, with a high prevalence of diabetes among affected patients.

Conclusions:

• These findings suggest that heparin may be beneficial in preventing DVT when rabbit antithymocyte globulin (RATG) is administered, especially via peripheral routes.
• The results support reconsidering the addition of heparin to RATG infusions to mitigate DVT risk in transplant patients.