From the Guidelines
Induction therapy in immunosuppressive treatment refers to the intensive initial phase of immunosuppression given at the time of organ transplantation to prevent acute rejection, and it is recommended to include induction therapy with a biologic agent as part of the initial immunosuppressive regimen in kidney transplant recipients 1.
Definition and Purpose
Induction therapy typically involves higher doses of immunosuppressive medications or specialized antibody therapies administered in the perioperative period. The goal of induction therapy is to deplete or block T-cell function, preventing the recipient's immune system from attacking the new organ during the critical early post-transplant period when rejection risk is highest.
Common Induction Agents
Common induction agents include:
- Anti-thymocyte globulin (ATG)
- Basiliximab (Simulect)
- Alemtuzumab (Campath)
- High-dose corticosteroids like methylprednisolone For example, basiliximab is often given as two 20mg doses: one before transplantation and another on day 4 post-transplant 1. ATG might be administered daily for 3-7 days at doses of 1-1.5 mg/kg.
Importance in High-Risk Transplant Recipients
Induction therapy is particularly important for high-risk transplant recipients, such as those who are highly sensitized or receiving a poorly matched organ. The use of induction agents can help reduce the risk of acute rejection and improve graft survival in these patients 1.
Recommendations
The KDIGO clinical practice guideline for the care of kidney transplant recipients recommends starting a combination of immunosuppressive medications before, or at the time of, kidney transplantation, and including induction therapy with a biologic agent as part of the initial immunosuppressive regimen 1. The guideline also suggests using a lymphocyte-depleting agent, rather than an IL2-RA, for kidney transplant recipients at high immunologic risk 1.
From the FDA Drug Label
All patients received prophylactic induction therapy consisting of an antilymphocyte antibody preparation, corticosteroids, and azathioprine. In a randomized, open-label, multicenter trial (Study 1), 1,589 kidney transplant patients received ... all patients, except those in one of the two cyclosporine groups, also received induction with daclizumab
Induction therapy in the context of immunosuppressive therapy refers to the initial treatment given to patients to induce immunosuppression, typically consisting of a combination of medications such as antilymphocyte antibody preparations, corticosteroids, and other immunosuppressive agents. The goal of induction therapy is to rapidly achieve a state of immunosuppression, reducing the risk of rejection in transplant patients. In the provided drug label, induction therapy is mentioned as a prophylactic measure, consisting of an antilymphocyte antibody preparation, corticosteroids, and azathioprine, and also as induction with daclizumab in a clinical trial 2.
From the Research
Definition of Induction Therapy
Induction therapy in the context of immunosuppressive therapy refers to the initiation of intense immunosuppression in the initial days after transplantation when the recipient's immune system contacts donor antigens for the first time 3, 4, 5. The primary goal of induction therapy is to prevent acute rejection during the early posttransplantation period by providing a high degree of immunosuppression at the time of transplantation 3.
Purpose of Induction Therapy
The purpose of induction therapy is to:
- Prevent acute rejection and graft loss 4
- Decrease the occurrence of early acute rejection 6
- Avoid or minimize corticosteroids 6
- Potentially induce long-term favorable immunoregulatory effects 6
Types of Induction Agents
Induction agents can be categorized into:
- Depleting antibodies (e.g., polyclonal antibodies, anti-CD3 antibodies, human monoclonal anti-CD52) 5
- Nondepleting antibodies (e.g., anti-CD25 antibodies, fusion proteins with natural binding properties) 5 Examples of induction agents include:
- Rabbit antithymocyte globulin 3, 4
- Alemtuzumab 3, 4
- Muromonab-CD3 3
- Rituximab 3, 4
- Basiliximab 3, 4
Considerations for Induction Therapy
The choice of induction therapy depends on various factors, including:
- Preexisting medical conditions 3
- Donor characteristics 3
- Maintenance immunosuppressive regimen to be used 3
- Special situations such as living-donor kidney transplant, pediatric transplant, hepatitis C virus-seropositive recipients, recipients who require desensitization, patients who are at risk for developing delayed graft function, and old donors 4