A Delayed Cardiopulmonary Reaction to an Intravenous Immunosuppressant Thymoglobulin After Pancreas Transplant

Loushin, Michael K.; Hasinoff, Ian K.; Belani, Kumar G.

doi:10.1097/00000539-200111000-00044

Cited by 12 publications

(7 citation statements)

References 4 publications

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“…In our series, one patient had an anaphylactic reaction to thymoglobulin, which has been described in case reports but not previously associated with hypoglycemia [9,10]. Another patient whose preoperative BG was normal had an unexpected hypoglycemic event, despite not taking any insulin or oral medications the morning of surgery.…”

Section: Failure To Monitor -Patients 2 3 4 6 and 15supporting

confidence: 58%

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Root causes of intraoperative hypoglycemia: a case series

Schwenk¹,

Mraović²,

Maxwell³

et al. 2012

Journal of Clinical Anesthesia

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Section: Failure To Monitor -Patients 2 3 4 6 and 15supporting

confidence: 58%

“…Ineffective Communication - Patients 1,2,9,10,13,15,and 16 Inadequate communication was at least partially responsible for seven hypoglycemic episodes (Table 1). Verbal instructions to hold the morning insulin in Patient 1 in the preoperative testing clinic were ineffective in achieving the desired goal.…”

Section: Most Common Root Causesmentioning

confidence: 99%

Root causes of intraoperative hypoglycemia: a case series

Schwenk¹,

Mraović²,

Maxwell³

et al. 2012

Journal of Clinical Anesthesia

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“…The most common complications are haematological (thrombocytopenia, granulocytopenia). However, rare cases of serious complications following thymoglobulin administration have been reported, including serum sickness [ 13 ], cardiopulmonary failure [ 14 ] and acute respiratory distress syndrome [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

An avoidable cause of thymoglobulin anaphylaxis

Facon

François

Labalette

et al. 2017

Allergy Asthma Clin Immunol

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BackgroundThymoglobulin® (anti-thymocyte globulin [rabbit]) is a purified pasteurised, gamma immune globulin obtained by immunisation of rabbits with human thymocytes. Anaphylactic allergic reactions to a first injection of thymoglobulin are rare.Case presentationWe report a case of serious anaphylactic reaction occurring after a first intraoperative injection of thymoglobulin during renal transplantation in a patient with undiagnosed respiratory allergy to rabbit allergens.ConclusionsThis case report reinforces the importance of identifying rabbit allergy by a simple combination of clinical interview followed by confirmatory skin testing or blood tests of all patients prior to injection of thymoglobulin, which is formally contraindicated in patients with a history of hypersensitivity to rabbit proteins.

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“…However, despite multiple reports demonstrating reasonable safety and possible medical advantages to SD-rATG induction in renal transplantation, there remains a concern in the transplant community as to the early safety of this approach (9,10,13,18,19). The present multicenter study was designed to rigorously address these remaining safety concerns using a primary composite end point based on either the physiologic consequences of a severe rATG reaction (fever, hypotension, hypoxia) or the possible severe sequelae (cardiac events and DGF) (20)(21)(22)(23)(24). This prospectively randomized doubleblind trial also used a double-dummy approach to help guarantee group concealment and eliminate clinician bias in interpreting and managing complications during and after rATG induction.…”

Section: Discussionmentioning

confidence: 99%

A Double-Blind, Double-Dummy, Flexible-Design Randomized Multicenter Trial: Early Safety of Single- Versus Divided-Dose Rabbit Anti-Thymocyte Globulin Induction in Renal Transplantation

Stevens

Wrenshall

Miles

et al. 2016

American Journal of Transplantation

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A previous nonblinded, randomized, single‐center renal transplantation trial of single‐dose rabbit anti‐thymocyte globulin induction (SD‐rATG) showed improved efficacy compared with conventional divided‐dose (DD‐rATG) administration. The present multicenter, double‐blind/double‐dummy STAT trial (Single dose vs. Traditional Administration of Thymoglobulin) evaluated SD‐rATG versus DD‐rATG induction for noninferiority in early (7‐day) safety and tolerability. Ninety‐five patients (randomized 1:1) received 6 mg/kg SD‐rATG or 1.5 mg/kg/dose DD‐rATG, with tacrolimus‐mycophenolate maintenance immunosuppression. The primary end point was a composite of fever, hypoxia, hypotension, cardiac complications, and delayed graft function. Secondary end points included 12‐month patient survival, graft survival, and rejection. Target enrollment was 165 patients with an interim analysis scheduled after 80 patients. Interim analysis showed primary end point noninferiority of SD‐rATG induction (p = 0.6), and a conditional probability of <1.73% of continued enrollment producing a significant difference (futility analysis), leading to early trial termination. Final analysis (95 patients) showed no differences in occurrence of primary end point events (p = 0.58) or patients with no, one, or more than one event (p = 0.81), or rejection, graft, or patient survival (p = 0.78, 0.47, and 0.35, respectively). In this rigorously blinded trial in adult renal transplantation, we have shown SD‐rATG induction to be noninferior to DD‐rATG induction in early tolerability and equivalent in 12‐month safety. (Clinical Trials.gov #NCT00906204.)

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A Delayed Cardiopulmonary Reaction to an Intravenous Immunosuppressant Thymoglobulin After Pancreas Transplant

Abstract: Adverse cardiopulmonary reaction to an intravenous immunosuppressant after solid organ transplantation might not be evident immediately in the postoperative period and might result in serious cardiopulmonary compromise.

Cited by 12 publications

References 4 publications

Root causes of intraoperative hypoglycemia: a case series

Root causes of intraoperative hypoglycemia: a case series

An avoidable cause of thymoglobulin anaphylaxis

A Double-Blind, Double-Dummy, Flexible-Design Randomized Multicenter Trial: Early Safety of Single- Versus Divided-Dose Rabbit Anti-Thymocyte Globulin Induction in Renal Transplantation

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