Controversies about induction therapy

Induction therapy refers to the initiation of intense immunosuppression in the initial days after transplantation when the recipient's immune system contacts donor antigens for the first time. Induction therapy may also be used to permit delayed initiation of calcineurin inhibitors (CNIs) for maintenance immunosuppression among patients with significant renal failure (RF). The rationale of its use is to provide intensive immunosuppression at the time when the alloimmune response is most intense. In general, induction therapy can be divided into 2 categories: depleting antibodies (eg, polyclonal antibodies [horse or rabbit antithymocyte globulin], anti-CD3 antibodies [OKT3], and human monoclonal anti-CD52 [alentuzumab]) and nondepleting antibodies (eg, anti-CD25 antibodies [daclizumab, basiliximab] or fusion proteins with natural binding properties currently being studied, eg, CTLA4-Ig [belatacept]). The advantages and disadvantages of induction therapy are discussed.