Background

Data on individualized immunosuppressive protocols for the pediatric heart recipients are missing in Europe. To contribute to this very small but specialized field, we describe the use of induction therapy (IT) in pediatric heart transplant patients in Switzerland and the retrospective outcomes.

Method

This is a retrospective national database analysis of children <19 years of age at time of heart transplantation (HT) from 05/2008–01/2018. Use of IT or no IT, use of steroids, calculated panel reactive antibodies (cPRA) and outcomes (Mortality, post-transplant lymphoproliferative disease (PTLD), rejection rates) were studied within a mean follow-up period of 2.9 years (0.2–8.1 years).

Results

All 32 patients (12♂, 20♀), median age at HT of 6.4 years (24 days - 18 years) received IT using either polyclonal antibodies (ATG; 72%) or interleukin-2 receptor antagonist (anti-IL-2R mAb; 28%). Length of treatment was median of 4 (1–63) days. At time of HT all patients received steroids, while at discharge 32% and one year after HT 19%. Kaplan-Meier analysis of survival revealed a one-year survival of 86%. Three out of 7 patients with elevated cPRA (43%) died. Median time to first treated rejection was 19.4 months (±60.5 SD) without significant difference if treated with anti-IL-2R mAb or ATG (p:0.5). No development of PTLD, chronic renal failure needing ongoing renal replacement therapy or diabetes mellitus were recorded.

Discussion

This is the first report of the national practice use of IT within Switzerland. It reveals a high use of IT, no development of PTLD and a low use of steroids at one-year post HT.

中文翻译：

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瑞士小儿心脏移植受者使用诱导治疗——瑞士国家数据库分析

背景

欧洲缺少儿科心脏受者个体化免疫抑制方案的数据。为了为这个非常小但专业的领域做出贡献，我们描述了在瑞士小儿心脏移植患者中使用诱导治疗 (IT) 的情况以及回顾性结果。

方法

这是对 2008 年 5 月 2 日至 2018 年 1 月心脏移植 (HT) 时年龄 <19 岁儿童的回顾性国家数据库分析。在平均 2.9 年 (0.2– 8.1 岁）。

结果

所有 32 名患者（12♂，20♀），HT 的中位年龄为 6.4 岁（24 天 - 18 岁）接受了使用多克隆抗体（ATG；72%）或白细胞介素 2 受体拮抗剂（抗 IL-2R mAb）的 IT ; 28%)。治疗时间的中位数为 4 (1-63) 天。在 HT 时，所有患者都接受了类固醇，而出院时 32% 和 HT 一年后 19%。Kaplan-Meier 生存分析显示一年生存率为 86%。7 名 cPRA 升高的患者中有 3 名（43%）死亡。如果用抗 IL-2R mAb 或 ATG 治疗，首次治疗排斥反应的中位时间为 19.4 个月 (±60.5 SD)，无显着差异 (p:0.5)。没有记录到发生 PTLD、需要进行肾脏替代治疗的慢性肾功能衰竭或糖尿病。

讨论

这是关于瑞士国内 IT 实践使用情况的第一份报告。它揭示了在 HT 后一年内 IT 的高使用率、PTLD 的发展和类固醇的低使用率。