Induction Immunosuppressive Therapy

Immunomodulatory regimens used for organ transplantation can be generally classified as induction, maintenance, or rescue therapies. Induction therapy is intense, prophylactic therapy used at the time of transplantation based on the empiric observation that the early requirements for immunomodulation exceed those late after transplantation. In general, the intensity of induction regimens is such that prolonged exposure is prohibitively toxic. However, when used appropriately, induction can reduce the incidence of acute rejection and simplify the early immune management of transplant recipients. They have not been convincingly shown to improve long-term outcomes and, as such, their clinical use remains largely based on institutional preference. This chapter will cover the emerging biological basis for induction therapy, review the common regimens used for this purpose, and provide reference to those trials elucidating their role in transplantation.