Page 63 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

Drug Protocols

Protocol for Administration of Anti-thymocyte Globulin (Thymoglobulin)

Thymoglobulin [Anti-thymocyte Globulin (Rabbit)] is a purified, pasteurized, gamma immune
globulin, obtained by immunization of rabbits with human thymocytes. It contains cytotoxic
antibodies directed against antigens expressed on human T-lymphocytes.

Indications: Thymoglobulin is used in combination with other immunosuppressive agents as
prophylaxis to prevent rejection during the early post-transplant phase as part of an induction
therapy protocol for selected children. Thymoglobulin may also be given to treat acute
rejection in conjunction with concomitant immunosuppression. Renal transplant team
recommends thymoglobulin as the induction agent for deceased donor kidney transplant and
any deviation is at the discretion of the attending physician.

Administration:

Premedication:
1 hour prior to administration:

 Methylprednisolone: 1-2 mg/kg IV infused over 1-2 hours ONCE, can reduce dose of
methylprednisolone after first 2 infusions of thymoglobulin.
 Acetaminophen: 10 – 15 mg/kg PO/NG (maximum: 650mg) X 1; then every 6 hours as needed
for pain/fever.
 Benadryl: 1mg/kg IV X 1; then every 6 hours as needed for itching

Dosing:
Induction Therapy: 1 .5 mg/kg IV daily for 5 - 10 days
Treatment of acute renal graft rejection: 1.5 mg/kg IV daily for 5 - 14 days
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 stopping

IV Infusion:
 Central-line or high-flow vein infusion is recommended
 Use a 0.22-micron in-line filter
 Initial infusion over a minimum of 6 hours and subsequent infusions over a

minimum of 4 hours
 Do not mix Thymoglobulin with other intravenous fluids or medications

Anaphylaxis:
 Discontinue Thymoglobulin immediately
 Initiate epinephrine, steroids, and other necessary resuscitative measures
 Do not re-challenge patient with Thymoglobulin

Updated November 9, 2017 63