CD3 monitoring and thymoglobulin therapy in cardiac transplantation: clinical outcomes and pharmacoeconomic implications

Transplant Proc. 2004 Dec;36(10):3245-9. doi: 10.1016/j.transproceed.2004.11.099.

Abstract

Introduction: CD3 monitoring of antithymocyte globulin therapy in renal transplantation has been shown to be more cost-effective than standard regimens. The objective of this study was to evaluate CD3 monitoring with Thymoglobulin in cardiac transplantation.

Methods: Cardiac transplant patients who required antithymocyte globulin therapy were dose-adjusted to maintain absolute CD3 counts <25 cells/microL. Endomyocardial biopsies and hemodynamic parameters were used to assess efficacy. The incidences of hematological side effects, opportunistic infections, and malignancies were recorded; in addition we performed a cost comparison.

Results: Eight patients were treated with Thymoglobulin using CD3 monitoring to adjust the dosing. All patients responded with few side effects. Compared to standard dosing, CD3 monitoring allowed a 60% reduction in the average total dose and a 58% reduction in cost per patient.

Conclusion: CD3 monitoring of Thymoglobulin therapy in cardiac transplant patients results in lower doses and reduced costs with equivalent efficacy and a low incidence of complications.

MeSH terms

  • Antigens, CD / blood
  • Antilymphocyte Serum / economics
  • Antilymphocyte Serum / therapeutic use*
  • CD3 Complex / blood*
  • Costs and Cost Analysis
  • Drug Monitoring / methods
  • Female
  • Heart Transplantation / economics
  • Heart Transplantation / immunology*
  • Humans
  • Immunosuppressive Agents / economics
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Middle Aged
  • Reoperation
  • Retrospective Studies
  • South Carolina
  • Treatment Outcome

Substances

  • Antigens, CD
  • Antilymphocyte Serum
  • CD3 Complex
  • Immunosuppressive Agents