Heart Transplant Induction Therapy in Canada: A National Survey

Purpose Indications and usage of induction therapy in heart transplantation is controversial. As a result, induction therapy is inconsistently used in heart transplant programs. We aimed to capture a point-prevalence view of opinions and utilization of induction therapy among adult Canadian heart transplant programs. Methods An electronic survey questionnaire was distributed to all heart transplant centers in Canada in August 2018. The survey consisted of 13 questions on site-specific induction therapy protocols, induction agent selection, dosing, and complications. Results All nine heart transplant centers in Canada completed the survey. Five centers (56%) use induction therapy on all patients and all centers use induction therapy on more than 50% of patients. Antithymocyte globulin (ATG) is the preferred drug in five centers (56%) whilst basiliximab (BAS) is the preferred drug in three centers (33%) . Only one center used a single agent (ATG) exclusively. For patients who were at higher risk of infection, BAS was preferred in eight (89%) centers. For patients who were at higher risk of kidney failure, ATG was preferred in 5 (56%) centers. Four centers (44%) used a reduced dose protocol more than 50% of the time when using ATG. Centers perceived that the relative increased risk of complications from induction therapy in descending order were: infection (21.4%), dehiscence (7.7%), acute respiratory distress syndrome (2.4%), and delirium (1.8%). Conclusion Induction therapy use is inconsistent across Canadian centers and may be more dependent on local practice patterns rather than on true efficacy or utility. Despite potential benefits, there were specific perceived concerns regarding the therapy. This clinical equipoise presents an opportunity for further prospective study.