Controversies About Induction Therapy

Alemtuzumab for Cytolytic Induction of Immunosuppression in Heart Transplant Recipients

“…Several lymphocyte depleting and nondepleting antibodies have displayed beneficial outcomes for induction of immunosuppression; however, the ideal induction strategy that balances efficacy against toxic effects remains elusive. [1][2][3][4][5] The first evaluation of alemtuzumab for induction of immunosuppression included a small population of patients and provided limited information on patients' characteristics. This retrospective cohort found similar overall mortality and freedom from significant rejection between groups, though alemtuzumab did extend the time to first rejection.…”

“…Induction of immunosuppression is characterized as administration of an immunosuppressant at the time of antigen presentation during the peritransplant period. 2,5 Although not required in transplant recipients, induction of immunosuppression may optimize patients' outcomes. In addition to reducing cellular rejection, induction of immunosuppression has been associated with improved graft survival, prevention of early nephropathy associated with calcineurin inhibitors, and minimization of steroid use.…”

Infection and rejection risk after cardiac transplantation with induction vs. no induction: a multi‐institutional study

“…Induction therapy in primary heart transplantation remains controversial due to non‐availability of large randomized clinical trials and as a result of conflicting studies on the subject . The perennial challenge is a balance between reducing the risk of rejection without increasing the risk of infections .…”