Zuckermann Andreas, Schulz Uwe, Deuse Tobias, Ruhpawar Arjang, Schmitto Jan D, Beiras-Fernandez Andres, Hirt Stephan, Schweiger Martin, Kopp-Fernandes Laurenz, Barten Markus J
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Transpl Int. 2015 Mar;28(3):259-69. doi: 10.1111/tri.12480. Epub 2014 Nov 11.
Clinical data relating to rabbit antithymocyte globulin (rATG) induction in heart transplantation are far less extensive than for other immunosuppressants, or indeed for rATG in other indications. This was highlighted by the low grade of evidence and the lack of detailed recommendations for prescribing rATG in the International Society for Heart and Lung Transplantation (ISHLT) guidelines. The heart transplant population includes an increasing frequency of patients on mechanical circulatory support (MCS), often with ongoing infection and/or presensitization, who are at high immunological risk but also vulnerable to infectious complications. The number of patients with renal impairment is also growing due to lengthening waiting times, intensifying the need for strategies that minimize calcineurin inhibitor (CNI) toxicity. Additionally, the importance of donor-specific antibodies (DSA) in predicting graft failure is influencing immunosuppressive regimens. In light of these developments, and in view of the lack of evidence-based prescribing criteria, experts from Germany, Austria, and Switzerland convened to identify indications for rATG induction in heart transplantation and to develop an algorithm for its use based on patient characteristics.
与心脏移植中兔抗胸腺细胞球蛋白（rATG）诱导治疗相关的临床数据，远比其他免疫抑制剂的相关数据少，甚至比rATG在其他适应症中的数据还要少。国际心肺移植学会（ISHLT）指南中关于rATG处方的证据等级较低且缺乏详细建议，就突出体现了这一点。心脏移植人群中，接受机械循环支持（MCS）的患者越来越多，这些患者常常伴有持续感染和/或致敏，免疫风险高，但也易发生感染并发症。由于等待时间延长，肾功能损害患者的数量也在增加，这就更需要采取策略将钙调神经磷酸酶抑制剂（CNI）的毒性降至最低。此外，供者特异性抗体（DSA）在预测移植物失败中的重要性也正在影响免疫抑制方案。鉴于这些进展，且由于缺乏循证处方标准，德国、奥地利和瑞士的专家齐聚一堂，确定心脏移植中rATG诱导治疗的适应症，并根据患者特征制定其使用算法。
