Induction Therapy for Lung Transplantation?
Induction Therapy for Lung Transplantation?
What are the current recommendations regarding induction therapy for lung transplantation?
There are no current recommendations with regard to induction therapy for lung transplantation and this remains one of the more controversial areas in the field. There have been a number of studies comparing different forms of induction therapy, but there has been no definitive study comparing induction vs no induction therapy. There are data showing that the number and severity of episodes of acute rejection can be reduced using induction therapy and that this may result in less chronic rejection. However, the controversy surrounds what this ultimately means for the patient. In this regard, there are no data to show that the use of induction therapy improves survival. This might be a consequence of the enhanced immunosuppression being balanced by an increased propensity for infection. If one looks at the practice habits of lung transplant centers, based on the most recent data from the International Society for Heart and Lung Transplantation, it appears that fewer patients are receiving induction therapy. In 2000, 46% of all lung transplants were induced, compared with 35% in 2002. In terms of the types of agents used, there also appears to have been a shift away from the more potent induction agents. Specifically in 2000, OKT3 was used in 6.5% of patients, compared with only 0.4% in 2002, whereas interleukin-2 receptor antagonists were used in 19.3% of patients in 2000 and 23% of patients in 2002. The fact that most programs now appear to withhold induction therapy might be influenced by the fact that many more deaths within the first year are infectious in nature rather than rejection-related.
What are the current recommendations regarding induction therapy for lung transplantation?
There are no current recommendations with regard to induction therapy for lung transplantation and this remains one of the more controversial areas in the field. There have been a number of studies comparing different forms of induction therapy, but there has been no definitive study comparing induction vs no induction therapy. There are data showing that the number and severity of episodes of acute rejection can be reduced using induction therapy and that this may result in less chronic rejection. However, the controversy surrounds what this ultimately means for the patient. In this regard, there are no data to show that the use of induction therapy improves survival. This might be a consequence of the enhanced immunosuppression being balanced by an increased propensity for infection. If one looks at the practice habits of lung transplant centers, based on the most recent data from the International Society for Heart and Lung Transplantation, it appears that fewer patients are receiving induction therapy. In 2000, 46% of all lung transplants were induced, compared with 35% in 2002. In terms of the types of agents used, there also appears to have been a shift away from the more potent induction agents. Specifically in 2000, OKT3 was used in 6.5% of patients, compared with only 0.4% in 2002, whereas interleukin-2 receptor antagonists were used in 19.3% of patients in 2000 and 23% of patients in 2002. The fact that most programs now appear to withhold induction therapy might be influenced by the fact that many more deaths within the first year are infectious in nature rather than rejection-related.
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