A Review of Induction with Rabbit Antithymocyte Globulin in Pediatric Heart Transplant Recipients

Area of Science:

• Pediatric Cardiology
• Transplantation Immunology
• Immunosuppression Therapy

Background:

• Pediatric heart transplantation (pHTx) is a small subset of cardiac transplants, limiting extensive clinical data on induction therapy.
• Induction therapy is more prevalent in pHTx than adults, often facilitating early steroid withdrawal or avoidance.
• Antithyphocyte globulin (ATG), particularly rabbit ATG (rATG), is the predominant induction agent in pHTx.

Purpose of the Study:

• To review existing literature and databases for evidence on the use, complications, and optimal dosage of rATG in pHTx.
• To evaluate the efficacy and safety of rATG compared to other induction agents in pediatric heart recipients.

Main Methods:

• Literature review of current studies and analysis of registry databases.
• Examination of clinical data regarding rATG use, complications, and patient outcomes in pHTx.

Main Results:

• Registry data indicate ATG preparations are linked to superior graft survival versus IL-2 receptor antagonists.
• rATG demonstrates benefits in low-risk patients on tacrolimus/mycophenolate mofetil with steroid-free regimens, sensitized patients, and ABO-incompatible pHTx.
• No increased risk of infection or post-transplant lymphoproliferative disorder was observed with rATG in pediatric recipients.

Conclusions:

• A total rATG dose of 3.5-7.5 mg/kg is recommended for pediatric heart transplantation.
• rATG is a valuable induction agent in pHTx, particularly for specific high-risk or steroid-avoiding scenarios.
• Further large-scale, prospective trials are needed to solidify evidence in this specialized field.