From the Research
Induction immunosuppressive therapy is recommended for most heart transplant recipients at the time of transplantation to prevent early acute rejection and reduce the risk of graft failure. The standard regimen typically includes either polyclonal antibodies like anti-thymocyte globulin (ATG) or interleukin-2 receptor antagonists such as basiliximab. ATG is usually administered at 1.5 mg/kg/day for 3-5 days post-transplant, while basiliximab is given as two 20 mg doses on day 0 and day 4 1.
Key Considerations
- Induction therapy is particularly important for patients at higher immunological risk, including those who are sensitized (have pre-formed antibodies), younger recipients, African American patients, those with previous transplants, or patients with ventricular assist devices.
- The therapy works by depleting or blocking T-lymphocytes, which are primarily responsible for acute cellular rejection.
- This initial intense immunosuppression allows for delayed introduction or reduced dosing of calcineurin inhibitors, potentially preserving renal function in the immediate post-transplant period.
- Side effects of induction therapy include increased risk of infections and potential for post-transplant lymphoproliferative disorder, so patients should be closely monitored during and after administration.
Choice of Induction Therapy
- Basiliximab has been shown to be safe and effective in heart transplant patients, with a low incidence of acute rejection and no severe adverse events 1.
- Rabbit anti-thymocyte globulin (RATG) has also been used as an induction agent, but its use has been associated with a higher rate of asymptomatic cytomegalovirus viral load detection in the plasma 2.
- The choice of induction therapy should be individualized based on the patient's risk factors and medical history.
Monitoring and Follow-up
- Patients receiving induction therapy should be closely monitored for signs of infection, rejection, and other adverse effects.
- Regular follow-up appointments and laboratory tests are necessary to adjust the immunosuppressive regimen as needed and minimize the risk of complications.