Induction Therapy: When and How

The idea of using induction therapy (IT) to improve patient outcomes after solid-organ transplant is appealing. In a basic sense, it is reasonable that early, potent immunosuppression should facilitate graft acceptance. Immunosuppression after HTx, and particularly IT, must balance the risk of early postoperative graft rejection against the increased risk of potentially life-threatening infections related to these medications. Regarding T-cell-specific antibody induction, the aim is to nullify effects of T-lymphocytes immediately after graft implant before full maintenance immunosuppression is achieved, by either inhibiting activation or depletion. Alemtuzumab is a humanized rat monoclonal antibody directed against the CD52 antigen expressed on lymphocytes, natural killer cells, monocytes, and thymocytes. The most common IT drugs used in contemporary practice are antithymocyte globulin (ATG) and basiliximab (BAS). Similar to daclizumab, BAS is an activated T-cell IL-2RA that competes with IL-2 for binding at the CD25 subunit.