Skip to main content
SpringerLink
Log in

Induction and Maintenance Agents

  • Living reference work entry
  • First Online:
Contemporary Heart Transplantation

Part of the book series: Organ and Tissue Transplantation ((OTT))

  • 110 Accesses

Abstract

Immunosuppression has increased the success of human heart transplant. There are specific patient groups that benefit from the use of induction therapy though the use of induction therapy has not shown universal benefit for all patients. Currently heart transplant centers employ dual or triple immunosuppression regimens with a calcineurin inhibitor as the base of the regimen and consideration given to antiproliferative agents or PSI/mTOR as the additional agent, with or without corticosteroids. The tolerability of agents can limit their use despite the therapeutic benefit, in addition to immunosuppression, toward renal sparing effects, viral sparing effects, or vasculopathy benefits. The choice of agents make individualization of immunosuppression possible based on a specific patient’s needs.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Alberu J, Pascoe MD, Campistol JM et al (2011) Lower malignancy rates in renal allograft recipients converted to sirolimus-based, calcineurin inhibitor-free immunotherapy: 24-month results from the CONVERT trial. Transplantation 92:303–301

    Article  CAS  Google Scholar 

  • Aliabadi A, Grommer M, Cochrane A et al (2013) Induction therapy in heart transplantation: where are we now? Transpl Int 26:684–695

    Article  CAS  Google Scholar 

  • Baran DA, Zucker MJ, Arroyo LH et al (2011) A prospective, randomized trial of single-drug versus dual-drug immunosuppression in heart transplantation, the tacrolimus in combination, tacrolimus alone compared (TICTAC) trial. Circ Heart Fail 4:129–137

    Article  CAS  Google Scholar 

  • Barnard JB, Thekkudan J, Richardson S et al (2006) Cyclosporine profiling with C2 and C0 monitoring improves outcomes after heart transplantation. J Heart Lung Transplant 25(5):564–568

    Article  CAS  Google Scholar 

  • Bouvier G, Cellerin L, Henry B et al (2009) Everolimus associated interstitial pneumonitis: 3 case reports. Respir Med CME 2(4):181–184

    Article  Google Scholar 

  • Brennan DC, Aguada JM, Potena L et al (2013) Effect of maintenance immunosuppressive drugs on virus pathobiology: evidence and potential mechanisms. Rev Med Virol 23:97–125

    Article  CAS  Google Scholar 

  • Campbell SB, Walker R, Tai SS et al (2012) Randomized controlled trial of sirolimus for renal transplant recipients at high risk for nonmelanoma skin cancer. Am J Transplant 12:1146–1156

    Article  CAS  Google Scholar 

  • Cantarovich M, Besner HG, Barkun JS et al (1998) Two-hour cyclosporine level determination is the appropriate tool to monitor neoral therapy. Clin Transpl 12(3):243–249

    CAS  Google Scholar 

  • Cantarovich M, Giannetti N, Barkun J, Cecere R (2004) Antithymocyte globulin induction allows a prolonged delay in the initiation of cyclosporine in heart transplant patients with postoperative renal dysfunction. Transplantation 75(5):779–781

    Article  Google Scholar 

  • Carrier M, Leblanc MH, Perrault LP et al (2007) Basiliximab and rabbit anti-thymocyte globulin for prophylaxis of acute rejection after heart transplantation: a non-inferiority trial. J Heart Lung Transplant 26:258–263

    Article  Google Scholar 

  • Delgado DH, Miriuka MD, Cusimano C et al (2005) Use of basiliximab and cyclosporine in heart transplant patients with pre-operative renal dysfunction. J Heart Lung Transplant 24:166–169

    Article  Google Scholar 

  • Euvrard S, Boissonnat P, Roussoulieres A et al (2010) Effect of everolimus on skin cancers in calcineurin inhibitor-treated heart transplant recipients. Transpl Int 23:855–857

    Article  CAS  Google Scholar 

  • Euvrard S, Morelon E, Rostaing L, et al. (2012) Sirolimus and secondary skin-cancer prevention in kidney transplantation. N Engl J Med 367:329–339

    Article  CAS  Google Scholar 

  • Flaman F, Zieroth S, Rao V, Ross H, Delgado DH (2006) Basiliximab versus rabbit anti-thymocyte globulin for induction therapy in patients after heart transplantation. J Heart Lung Transplant 25:1358–1362

    Article  Google Scholar 

  • Grimm M, Rinaldi M, Yonan NA et al (2006) Superior prevention of acute rejection by tacrolimus vs. cyclosporine in heart transplant patients – a large European trial. Am J Transplant 6:1387–1397

    Article  CAS  Google Scholar 

  • Guba M, Graeb C, Jauch KW et al (2004) Pro- and anti-cancer effects of immunosuppressive agents used in organ transplantation. Transplantation 77(12):1777–1782

    Article  CAS  Google Scholar 

  • Hermann M, Enseleit F, Fisler AE et al (2011) Cyclosporine C0- versus C2-monitoring over three years in maintenance heart transplantation. Swiss Med Wkly 141:w13149

    PubMed  Google Scholar 

  • Hertig A, Zuckermann AO (2015) Rabbit antithymocyte globulin induction and risk of post-transplant lymphoproliferative disease in adult and pediatric solid organ transplantation: an update. Transpl Immunol 32(3):179–187

    Article  CAS  Google Scholar 

  • Jeong H, Kaplan B (2007) Therapeutic monitoring of mycophenolate mofetil. CJASN 2(1):184–191

    Article  CAS  Google Scholar 

  • Kaczmarek I, Ertl B, Schmauss D et al (2006) Preventing cardiac allograft vasculopathy: long-term beneficial effects of mycophenolate mofetil. J Heart Lung Transplant 25(5):550–556

    Article  Google Scholar 

  • Kittleson M, Patel J, Rafiei M et al (2013) Failed prednisone taper off after heart transplant: is there a price to be paid? J Heart Lung Transplant 32(4):S200

    Article  Google Scholar 

  • Kobashigawa J, Miller L, Renlund D et al (1998) A randomized active-controlled trial of mycophenolate mofetil in heart transplant recipients. Transplantation 66(4):507–515

    Article  CAS  Google Scholar 

  • Kobashigawa J, Mehra M, West L et al (2009) Report from a consensus conference of the sensitized patient awaiting heart transplantation. J Heart Lung Transplant 28(3):213–225

    Article  Google Scholar 

  • Levy G, Thervet E, Lake J et al (2002) Patient management by neoral C2 monitoring: an international consensus statement. Transplantation 73(9):S12–S18

    Article  Google Scholar 

  • Marks WH, Ilsley JN, Dharnidkarka VR (2011) Posttransplant lymphoproliferative disorder in kidney and hear transplant patients receiving thymoglobulin: a systematic review. Transplant Proc 43(5):1395–1404

    Article  CAS  Google Scholar 

  • Masetti M, Potena L, Nardozza M et al (2013) Differential effects of everolimus on progression of early and late cardiac allograft vasculopathy in current clinical practice. Am J Transplant 13:1217–1226

    Article  CAS  Google Scholar 

  • Mattei M, Redonnet M, Gandjbakchc I et al (2007) Lower risk of infectious deaths in cardiac transplant patients receiving basiliximab versus anti0thymocyte globulin as induction therapy. J Heart Lung Transplant 26:693–699

    Article  Google Scholar 

  • Mehra MR, Zucker MJ, Wagoner L et al (2005) A multicenter prospective randomized double blind trial of basiliximab in heart transplantation. J Heart Lung Transplant 24:1297–1304

    Article  Google Scholar 

  • Molas-Ferrer G, Soy-Muner D, Anglada-Martinez H et al (2013) Interstitial pneumonitis as an adverse reaction to mTOR. Nefrologia 33(3):297–300

    PubMed  Google Scholar 

  • Rosenberg PB, Vriesendorp AE, Drazner MH et al (2005) Induction therapy with basiliximab allows delayed initiation of cyclosporine and preserves renal function after cardiac transplantation. J Heart Lung Transplant 24:1327–1331

    Article  Google Scholar 

  • Salgo R, Grossman J, Schofer H et al (2010) Switch to sirolimus based immunosuppression in long-term renal transplant recipients: reduced rate of (pre-) malignancies and nonmelanoma skin cancer in a prospective, randomized, assessor-blinded, controlled clinical trial. Am J Transplant 10:1395–1393

    Article  Google Scholar 

  • Sollinger HW (1995) Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients. Transplantation 60(3):225–232

    Article  CAS  Google Scholar 

  • Taylor DO, Barr ML, Radovancevic B et al (1999) A randomized, multicenter comparison of tacrolimus and cyclosporine immunosuppressive regimens in cardiac transplantation: decreased hyperlipidemia and hypertension with tacrolimus. J Heart Lung Transplant 18:336–345

    Article  CAS  Google Scholar 

  • Teuteberg JJ, Shullo MA, Zomak R et al (2009) Alemtuzumab induction prior to cardiac transplantation with lower intensity maintenance immunosuppression: one-year outcomes. Am J Transplant 10:382–388

    Article  Google Scholar 

  • van Gelder T, Klupp J, Barten MJ et al (2001) Comparison of the effects of tacrolimus and cyclosporine on the pharmacokinetics of mycophenolic acid. Ther Drug Monit 23(2):19–128

    Google Scholar 

  • Van Gelder T, Meur YL, Shaw L et al (2006) Therapeutic drug monitoring of mycophenolate mofetil in transplantation. Ther Drug Monit 28(2):145–154

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Inova Fairfax Hospital, Falls Church, VA, USA

    Adam Cochrane

Authors
  1. Adam Cochrane
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam Cochrane .

Editor information

Editors and Affiliations

  1. Cardiac, Vascular and Thoracic Surgery, Inova Fairfax Hospital, Falls Church, VA, VA, USA

    Linda Bogar

  2. Heart Failure/Transplant Cardiologist, The Cleveland Clinic Foundation, Cleveland, OH, OH, USA

    Maria Mountis

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Cochrane, A. (2019). Induction and Maintenance Agents. In: Bogar, L., Mountis, M. (eds) Contemporary Heart Transplantation. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-33280-2_20-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-33280-2_20-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33280-2

  • Online ISBN: 978-3-319-33280-2

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation