Induction treatment with monoclonal antibodies for heart transplantation.
Individualization of induction therapy for heart transplantation (HT) is needed, given that only patients at significant risk for fatal rejection seem to present a favorable risk-benefit ratio. The question whether monoclonal interleukin 2 antagonists or antilymphocyte antibodies should be recommended remains unanswered. As most studies suggest that they have similar efficacy in preventing acute rejection, other variables related to safety or management costs should be taken into account. The cytokine release syndrome, associated with the use of OKT3, complicates management of HT patient. The experience in our center with 2 consecutive cohorts, treated with basiliximab (BAS) and OKT3, respectively, suggests that the use of BAS is associated, in addition to similar immunosuppressive efficacy and better safety profile than OKT3, with simpler patient management during the initial hospital stay, which could be associated with a reduction in posttransplant costs. Because few centers continue to use OKT3 as induction therapy in HT, more studies comparing cost-effectiveness of BAS vs polyclonal antilymphocyte antibodies (ATG) are needed.
Heart Failure and Transplantation Unit, Department of Cardiology, Doce de Octubre Hospital, 28041 Madrid, Spain. jdelgado.hdoc@salud.madrid.org
Juan F
JF
Delgado
David
D
Vaqueriza
Violeta
V
Sánchez
Pilar
P
Escribano
Maria J
MJ
Ruiz-Cano
Emilio
E
Renes
Miguel A
MA
Gómez-Sánchez
Jose M
JM
Cortina
Carlos S
CS
de la Calzada
D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000077552:Basiliximab; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016853:Muromonab-CD3 / Q000008:administration & dosage*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012189:Retrospective Studies; D012307:Risk Factors
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab