Induction therapy in heart transplantation: A systematic review and network meta-analysis for developing evidence-based recommendations

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dc.contributor.authorKugathasan, Lakshmi
dc.contributor.authorRayner, Daniel G.
dc.contributor.authorWang, Sabrina Mianchen
dc.contributor.authorRodenas-Alesina, Eduardo
dc.contributor.authorOrchanian-Cheff, Ani
dc.contributor.authorStehlik, Josef
dc.contributor.authorGustafsson, Finn
dc.contributor.authorGreig, Douglas
dc.contributor.authorMcdonald, Michael
dc.contributor.authorBertolotti, Alejandro Mario
dc.contributor.authorDemas-Clarke, Penny
dc.contributor.authorKozuszko, Stella
dc.contributor.authorGuyatt, Gordon
dc.contributor.authorForoutan, Farid
dc.contributor.authorAlba, Ana Carolina
dc.date.accessioned2025-01-20T16:19:30Z
dc.date.available2025-01-20T16:19:30Z
dc.date.issued2024
dc.description.abstractIntroduction: Induction therapy (IT) utility in heart transplantation (HT) remains contested. Commissioned by a clinical-practice guidelines panel to evaluate the effectiveness and safety of IT in adult HT patients, we conducted this systematic review and network meta-analysis (NMA). Methods: We searched for studies from January 2000 to October 2022, reporting on the use of any IT agent in adult HT patients. Based on patient-important outcomes, we performed frequentist NMAs separately for RCTs and observational studies with adjusted analyses, and assessed the certainty of evidence using the GRADE framework. Results: From 5156 publications identified, we included 7 RCTs and 12 observational studies, and report on two contemporarily-used IT agents-basiliximab and rATG. The RCTs provide only very low certainty evidence and was uninformative of the effect of the two agents versus no IT or one another. With low certainty in the evidence from observational studies, basiliximab may increase 30-day (OR 1.13; 95% CI 1.06-1.20) and 1-year (OR 1.11; 95% CI 1.02-1.22) mortality compared to no IT. With low certainty from observational studies, rATG may decrease 5-year cardiac allograft vasculopathy (OR .82; 95% CI .74-.90) compared to no IT, as well as 30-day (OR .85; 95% CI .80-.92), 1-year (OR .87; 95% CI .79-.96), and overall (HR .84; 95% CI .76-.93) mortality compared to basiliximab. Conclusion: With low and very low certainty in the synthetized evidence, these NMAs suggest possible superiority of rATG compared to basiliximab, but do not provide compelling evidence for the routine use of these agents in HT recipients.
dc.fuente.origenWOS
dc.identifier.doi10.1111/ctr.15326
dc.identifier.eissn1399-0012
dc.identifier.issn0902-0063
dc.identifier.urihttps://doi.org/10.1111/ctr.15326
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/90693
dc.identifier.wosidWOS:001215659800001
dc.issue.numero5
dc.language.isoen
dc.revistaClinical transplantation
dc.rightsacceso restringido
dc.subjectfusion proteins and monoclonal antibodies: basiliximab/daclizumab
dc.subjectimmunosuppressant
dc.subjectImmunosuppressant
dc.subjectimmunosuppressive regimens
dc.subjectinduction
dc.subjectpolyclonal preparations: rabbit antithymocyte globulin
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleInduction therapy in heart transplantation: A systematic review and network meta-analysis for developing evidence-based recommendations
dc.typeartículo
dc.volumen38
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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