Immunosuppressive T-cell antibody induction for heart transplant recipients

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

“…Although more trials are needed, especially with regard to the comparison of ATG vs. no induction, it appears from the above reports as if both drugs could have benefits in terms of preventing ACR, and that ACR could be somewhat better prevented with ATG than with IL-2 receptor antagonists. Except for the possible benefit on ACR with ATG over no induction (for which there are no trials), similar conclusions were made in the recently mentioned Cochrane review by Penninga et al [24]. However, the authors of the review underscore the uncertainty in such conclusions and encourage more randomized trials to clarify the benefits and harms of these, and other, induction therapies.…”

“…To address the uncertainties on the potential benefits and harms of induction therapy in HT, Penninga et al recently made a Cochrane review with a meta-analysis of 22 randomized trials [24]. Major outcomes studied were; mortality, ACR, CAV, infection, malignancy, and renal function.…”

Impact of induction immunosuppression on survival in heart transplant recipients: a contemporary analysis of agents

“…This would be an important question to answer in the setting of induction therapy. A potential downside is that there could be a predisposition to increased infection with induction therapy, in particular with cytomegalovirus but reports are inconsistent in this matter . Similarly, information on whether patients developed malignancies or cardiac allograft vasculopathy during follow‐up was not available, as well as certain demographic factors, such as pre‐transplant PRA,…”

Approach to the Sensitized Patient Awaiting Heart Transplantation

“…A recent meta-analysis of randomized clinical trials suggested a signal for less rejection with interleukin-2 receptor antibody (IL-2RAb) induction compared to placebo and superiority of cytolytic induction with anti-thymocyte globulin (ATG) over IL-2RAb [43]. There are two polyclonal IgG cytolytic preparations of ATG that available for use: Thymoglobulin®, which is rabbit-derived (rATG) anti-human T cell antibodies, and ATGAM, which is equinederived anti-human T cell antibodies.…”