Page 17 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

 Taper corticosteroids at a rate of 0.05 mg/kg at monthly intervals
 Corticosteroids will be maintained for a minimum of 6 months. If there are any acute rejection
episodes during the first 6 months post-transplant maintain corticosteroids for at least 12
months.

Immunosupression

Induction therapy is used in pediatric heart transplantation to reduce the incidence of early rejection,
maintenance steroids and delay the introduction of calcineurin inhibitors to enable renal function to
normalize in the early post-transplant period. It is recognized that although this is common practice the
evidence base is slim.

Pre-Transplant Immunosuppression Orders

 Pre-operative dose of MMF (Cellcept): 50mg/kg x 1 dose PO/IV (max dose 2G) to be given 2
hours prior to OR
 Intra-Operative dose of Methylprednisolone: (1 dose)
o 30mg/kg IV (max dose of 1G) given by perfusionist with pump prime or prior to release
of aortic cross-clamp

Post-Transplant Immunosuppression Protocols

 Induction
o Thymoglobulin – 2 mg/kg/dose IV, first dose to be given within 4-6 hours of being back
in CVICU (no maximum)
o Thymoglobulin via CVL and 0.22-micron filter, daily for up to 7 doses (dose adjusted
based on daily CD3 count)
o Infuse first dose over a minimum of 6 hours and subsequent doses over 4 hours
o Pre-medicate (Prior to infusion):
 Tylenol 15 mg/kg (max dose 650 mg) NG/Rectal/IV
 Benadryl 1 mg/kg (max dose 50 mg) NG/IV
 Daily Methylprednisolone
 If Thymoglobulin is necessary once steroids have been stopped, give 0.5
mg/kg/dose as pre-medication for Thymoglobulin
o Dosage adjustment:
 WBC count 2000 - 3000 cell/mm3 or platelet count 50,000 - 75,000 cells/mm3:
reduce dose by 50%
 WBC count < 2000 cells/mm3 or platelet count < 50,000 cells/mm 3: Consider
temporary discontinuation of Thymoglobulin
o Lab Monitoring
 Obtain daily CD3 counts for 7 days, hold thymoglobulin for CD3 <50 cells/mm3

Updated November 9, 2017 17