Page 16 - Heart Transplant Guidelines
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Heart Function Service: Heart Transplant Guidelines

                   •  A 1-1.5 volume exchange will be performed daily for the first five days after transplantation
                   •  Further days of plasmapheresis may be given at the discretion of the transplant team

               Intravenous Immunoglobulin (IVIG):

               First dose to be given within 24 hours of the last planned plasmapheresis post-transplant (may give as a
               single 2 g/kg infusion or 2 x 1 g/kg infusions over two days). Five additional doses will be given at
               monthly intervals.

               Corticosteroids:

                   •  Post-operative day 1-5 as per routine guideline
                   •  After post-operative day 5, daily dosing of 0.25 mg/kg/day, with a maximum dose of 20 mg daily
                   •  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 Guidelines

                   •  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








               Updated December 14, 2018                                                                   16
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