Induction Therapy in Heart Transplantation: A Systematic Review and Network Meta-Analysis

Kugathasan, L.; Wang, S.M.; Rodenas-Alesina, E.; Orchanian‐Cheff, Ani; Kozuszko, Stella; Demas-Clarke, P.; Bertolotti, Alejandro; Greig, Douglas; Gustafsson, F.; Stehlik, J.; Badiwala, Mitesh; McDonald, Madeline; Foroutan, Farid; Alba, Ana Carolina

doi:10.1016/j.healun.2022.01.358

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“…The evidence on its use is limited to small randomized controlled trials (RCTs) that remain underpowered even when combined in meta-analyses, and observational data with high risk of bias. 3,4 Over the years, various IT agents have been used and many are no longer available for clinical care (OKT3 and Daclizumab). 5 Today, only two agents are available for use in HTx: Basiliximab and Thymoglobulin.…”

Section: Introductionmentioning

confidence: 99%

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Use of induction therapy post‐heart transplantation: Clinical practice recommendations based on systematic review and network meta‐analysis of evidence

Foroutan,

Guyatt,

Stehlik

et al. 2024

Clinical Transplantation

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BackgroundThe use of induction therapy (IT) agents in the early post‐heart transplant period remains controversial. The following recommendations aim to provide guidance on the use of IT agents, including Basiliximab and Thymoglobulin, as part of routine care in heart transplantation (HTx).MethodsWe recruited an international, multidisciplinary panel of 15 stakeholders, including patient partners, transplant cardiologists and surgeons, nurse practitioners, pharmacists, and methodologists. We commissioned a systematic review on benefits and harms of IT on patient‐important outcomes, and another on patients’ values and preferences to inform our recommendations. We used the GRADE framework to summarize our findings, rate certainty in the evidence, and develop recommendations. The panel considered the balance between benefits and harms, certainty in the evidence, and patient's values and preferences, to make recommendations for or against the routine post‐operative use of Thymoglobulin or Basiliximab.ResultsThe panel made recommendations on three major clinical problems in HTx: (1) We suggest against the routine post‐operative use of Basiliximab compared to no IT, (2) we suggest against the routine use of Thymoglobulin compared to no IT, and (3) for those patients for whom IT is deemed desirable, we suggest for the use of Thymoglobulin as compared to Basiliximab.ConclusionThis report highlights gaps in current knowledge and provides directions for clinical research in the future to better understand the clinical utility of IT agents in the early post heart transplant period, leading to improved management and care.

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Section: Introductionmentioning

confidence: 99%

“…The use of IT, however, is controversial. The evidence on its use is limited to small randomized controlled trials (RCTs) that remain underpowered even when combined in meta‐analyses, and observational data with high risk of bias 3,4 …”

Section: Introductionmentioning

confidence: 99%