Is induction therapy still needed in heart transplantation?

Abstract

Induction therapy still has its place in the immunosuppressive armamentarium after cardiac transplantation. New antibody generations and the selection of special patient groups demonstrate that induction therapy is effective and well tolerated in its use.

Immunosuppressive therapies after heart transplantation — The balance between under- and over-immunosuppression

“…IL-2 receptor antagonist, in contrast, act through the binding of the IL-2 receptor located on T-cells, thereby inhibiting the proliferation and differentiation of Tlymphocytes (as seen in Fig. 1) [25].…”

Heart transplantation and mechanical circulatory support - From established treatment to current trends in management of end-stage heart failure

“…However, current data do not allow a firm conclusion on the benefit of induction therapy. The advantage over an immunosuppressive protocol without induction is not clear [9,19]. Data from the 2011 ISHLT registry show no survival benefit in patients who received induction therapy as compared to those without induction [9].…”

“…Data from the 2011 ISHLT registry show no survival benefit in patients who received induction therapy as compared to those without induction [9]. Randomised trials with induction therapy are lacking [19]. No recent randomised trials comparing ATG with no induction exist.…”

“…Alternatively, the pumps were located paracorporeally outside the body, like the Thoratec VAD (Thoratec Inc., Pleasanton, CA, USA) and the Berlin Heart Excor (Berlin Heart GmbH, Berlin, Germany) [27,28]. Although, with increasing experience, survival on the device reached rates of approximately 60-70%, adverse events including thrombosis and embolism, b leeding, infection, and mechanical failure, as well as patient discomfort due to the size and noisiness of the pumps, precluded more exlows a delay in onset of treatment with nephrotoxic CNI without running a higher risk of acute rejection [19].…”

“…No recent randomised trials comparing ATG with no induction exist. Trials comparing IL-2R antagonists with no induction have shown contradictory results [19,20]. Alemtuzumab was analysed against no induction in a large retrospective study showing a significant reduction in rejection episodes.…”