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Induction therapy with antithymocyte globulin before reperfusion.

Samuel B Goldfarb¹, J William Gaynor, Stephanie Fuller

¹Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. goldfarb@email.chop.edu

The Annals of Thoracic Surgery

|September 28, 2010

Summary

This summary is machine-generated.

Early administration of antilymphocyte globulin (ATG) before lung reperfusion in pediatric lung transplant recipients significantly reduced acute cellular rejection (ACR) incidence within six months post-transplant.

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Area of Science:

Pediatric transplantation
Immunosuppression therapy
Pulmonary medicine

Background:

Induction immunosuppressive agents are not universally used in pediatric lung transplantation.
Rationale for induction therapy is to mitigate acute cellular rejection (ACR) risk during the early post-transplant period.
Timing of induction immunosuppression varies, prompting investigation into optimal protocols.

Purpose of the Study:

To evaluate the efficacy of early antilymphocyte globulin (ATG) administration prior to donor lung reperfusion in reducing ACR incidence in pediatric lung transplant recipients.
To assess the safety and effectiveness of a specific ATG induction protocol in a pediatric cohort.

Main Methods:

ATG was administered intraoperatively before reperfusion and continued for four days post-transplant.
Pediatric patients (n=18) were monitored for ACR using transbronchial biopsies within the first six months post-transplant.
ACR diagnosis followed International Society for Heart & Lung Transplantation guidelines.

Main Results:

A single episode of ACR (≥ grade A2) occurred in 18 patients, resulting in a 5.2% incidence rate.
Sixty-three flexible bronchoscopies with transbronchial biopsies were performed during the initial six months.
The study observed a low incidence of ACR in patients receiving ATG induction therapy.

Conclusions:

Pre-reperfusion induction therapy with ATG is associated with a low incidence of ACR in pediatric lung transplant recipients within the first six months.
Further long-term follow-up is necessary to determine the complete impact of this ATG induction protocol on transplant outcomes.