Use of induction therapy post-heart transplantation: Clinical practice recommendations based on systematic review and network meta-analysis of evidence.
Foroutan, F., et al.Clinical Transplantation 2024; 38(3): e15270.
Aims
The aim of this paper was to provide clinical practice guidelines based on a systematic review investigating the role of induction therapy in heart transplant recipients.
Interventions
A multidisciplinary panel of stakeholders were recruited. A systematic review was performed to inform recommendations. The GRADE framework was used to summarise findings, rate certainty of evidence and develop recommendations.
Participants
A panel of 15 stakeholders, which included patient partners, nurse practitioners, transplant surgeons and cardiologists, pharmacists,and methodologists.
Outcomes
The main outcomes considered by the panel were all-cause mortality, rejection requiring treatment, need for dialysis or renal dysfunction, need for re-transplantation, malignancies, cardiac allograft vasculopathy, onset of heart failure symptoms, infections, quality of life, post-surgical bleeding, length of stay and delayed start of toxic immunosuppressants due to risk of acute kidney injury.
Follow-up
N/A
CET Conclusions
This paper reports on a systematic review in heart transplantation and the clinical practice recommendations made based upon this evidence. Unfortunately, the paper does not give a great deal of information about the systematic review that underpins the recommendations. For example, there is no search strategy, list of databases, flow chart or description of data extraction or quality assessment methods. The 12 included studies were all observational, if large (155,212 patients) and of low or very low quality. Therefore, the effects of the interventions were uncertain. The recommendations are very clear and are presented in a straightforward infographic. In short: there is very low certainty evidence that using no induction therapy is preferable to Basiliximab or Thymoglobulin and there is low certainty evidence that if induction therapy is deemed desirable, then Thymoglobulin is preferable to Basiliximab.
Trial registration
N/A