[Induction immunosuppressive therapy in patients undergoing heart transplantation]

Bussières S, Moisan M, Aumont F, Châteauvert N, Lacasse Y
Record ID 32018005140
Original Title: Induction de l’immunosuppression chez les patients qui subissent une transplantation cardiaque
Authors' objectives: Heart transplantation is a surgical procedure that is used when heart failure or other end-stage cardiomyopathy cannot be treated with drugs or other surgical procedures. Several complications are possible following a heart transplant, including rejection of the graft. To prevent the risk of rejection of the new organ, immunosuppressive therapy is administered, which includes two phases: induction and maintenance. At present, the relevance of induction therapy and the efficacy of the different agents available are controversial in the scientific literature. The Pharmacy Department at the Quebec Heart and Lung Institute – Laval University requested that the Health Technology Assessment Unit evaluate the best practices for induction immunosuppressive therapy in patients undergoing heart transplantation.
Authors' results and conclusions: Analysis of the available body of evidence was inconclusive regarding the effect of induction immunosuppressive therapy on the risk of mortality and graft rejection when compared to no induction therapy. The incidence of acute rejection may, however, be reduced in patients treated with an interleukin-2 receptor antagonist (IL-2 RA) compared to no induction, and in patients treated with the polyclonal antibody anti-thymocyte globulin (ATG) compared to an IL-2 RA.
Authors' recommendations: From the perspectives of clinical relevance and better use of resources, induction immunosuppressive therapy in all patients undergoing heart transplantation is a practice that could be reconsidered. According to professional bodies that have spoken out about induction immunosuppressive therapy, ATG could be given to a population deemed at high risk of acute rejection. Induction of immunosuppression in heart transplantation may also be a strategy to delay the introduction of calcineurin inhibitors in patients with impaired renal function. In light of these data, the protocol for induction of immunosuppression could be revised in order to assess and consider ATG in cases with a high risk of rejection.
Project Status: Completed
Year Published: 2019
Requestor: Pharmacy Department
English language abstract: There is no English language summary available
Publication Type: Full HTA
Country: Canada
Province: Quebec
MeSH Terms
  • Heart Transplantation
  • Immunosuppression Therapy
  • Antibodies, Monoclonal
Organisation Name: Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval (IUCPQ-ULaval)
Contact Address: 2725, chemin Sainte-Foy Québec QC G1V 4G5
Contact Name: uetmis.iucpq@ssss.gouv.qc.ca
Contact Email: uetmis.iucpq@ssss.gouv.qc.ca
Copyright: Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval
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