Clinical heart transplantationTo induce or not to induce: Do patients at greatest risk for fatal rejection benefit from cytolytic induction therapy?
Section snippets
Definition of induction
Induction therapy was defined as prophylactic lymphocytolytic therapy initiated within 48 hours of transplantation. The following preparations were considered lymphocytolytic therapy: OKT3, anti-thymocyte globulin (ATG), anti-lymphocyte globulin (ALG), anti-thymocyte serum (ATS) and thymoglobulin. Interleukin-2 receptor blockers were not considered induction therapy for this analysis.
Patient population
The CTRD is a multi-institutional event-driven analysis that includes 33 North American heart transplant
Differences between OKT3 and anti-thymocyte preparations
Separate analyses of the OKT3 group and the group receiving polyclonal anti-thymocyte/anti-lymphocyte preparations yielded the same effect of induction and non-induction on rejection death and overall mortality. Therefore, we have reported only the analysis that combines OKT3 and ATG patients together as the induction group.
Trends in use of induction therapy
Over the last 12 years of the CTRD, 67% of the patients undergoing primary cardiac transplantation received no induction therapy, whereas nearly 30% received induction with
Discussion
Acute rejection continues to be an important cause of early and mid-term mortality after cardiac transplantation.10, 11, 12 Multiple modalities have been employed to reduce the fatal consequences of rejection.13, 14 However, the potential for mortality results not only from the rejection phenomena, but also from infections and malignancies that can complicate aggressive immunosuppression.15 There has been controversy about the potential advantages and deleterious effects of induction therapy
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Cited by (79)
Racial and socioeconomic disparities in pediatric heart transplant outcomes in the era of anti-thymocyte globulin induction
2022, Journal of Heart and Lung TransplantationCitation Excerpt :We hoped that newer induction and immunosuppression strategies would improve race-related outcome disparities seen in older studies.14 ATG induction specifically can benefit patients with high rejection risk, broadly reducing rejection risk and impacting long term graft loss and coronary allograft vasculopathy.7,8,23-25 Our analysis suggests that this benefit is insufficient to completely mitigate late graft loss risks influenced by Black race and social determinants of health.
Post-transplant mortality and graft failure after induction immunosuppression among Black heart transplant recipients in the United States
2022, American Journal of TransplantationGene expression profiling and racial disparities in outcomes after heart transplantation
2019, Journal of Heart and Lung TransplantationInduction regimen and survival in simultaneous heart-kidney transplant recipients
2018, Journal of Heart and Lung TransplantationRisk stratification to determine the impact of induction therapy on survival, rejection and adverse events after pediatric heart transplant: A multi-institutional study
2018, Journal of Heart and Lung Transplantation