Total lymphoid irradiation: Is there a role in pediatric heart transplantation?

J. K. Kirklin, J. F. George, D. C. McGiffin, D. C. Naftel, M. M. Salter, R. C. Bourge

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Abstract

Total lymphoid irradiation (TLI) is an effective adjunct in the therapy of recurrent allograft rejection in adult patients. Between Jan. 3, 1990, and Feb. 5, 1992, TLI was used in 43 heart transplant patients 4 days to 67 months (mean, 6 months) after heart transplantation for recurrent allograft rejection. A mean TLI dose of 700 cGy (range, 40 to 1120 cGy-) was administered during a mean of 7 weeks with adjustment in overall dose and duration determined in part by leukopenia, thrombocytopenia, or both. Among patients who received TLI therapy within 1 month of transplantation (n = 12), the rejection rate decreased from 1.9 episodes per patient per month before TLI to 0.1 episodes per patient per month after TLI (p < 0.001). Sixty percent of patients had no further rejection episodes for 6 months after TLI. Peripheral blood mononuclear cells from two patients were specifically unreactive toward donor stimulator cells in mixed-lymphocyte cultures at 2.5 and 6 months after TLI. During this experience three pediatric patients (ages 10 to 17 years) received TLI at 0.5, 0.8, and 0.9 months after heart transplantation for recurrent allograft rejection. The total TLI dosage for each patient was 720, 800, and 800 cGy. The rejection frequency fell from 1.8 episodes per patient per month before TLI to 0.1 episodes after TLI (p < 0.01). During follow-up of 6 to 25 months after TLI, no adverse sequelae of TLI were identified. One 10-year-old patient who received a course of TLI immediately before retransplantation has had no rejection episodes during 2 years of follow-up. Inferences: TLI is an effective adjunct for intermediate- term control of recurrent allograft rejection in adults and also appears to be a safe adjunct in at least older pediatric patients. In some patients TLI is associated with the development of donor-specific tolerance.

Original languageEnglish
Pages (from-to)S293-S300
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume12
Issue number6 II
Publication statusPublished - 1 Dec 1993
Externally publishedYes

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