{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:49:07Z","timestamp":1792446547854,"version":"4.5.0"},"reference-count":33,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T00:00:00Z","timestamp":1715126400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Induction therapy (IT) utility in heart transplantation (HT) remains contested. Commissioned by a clinical\u2010practice guidelines panel to evaluate the effectiveness and safety of IT in adult HT patients, we conducted this systematic review and network meta\u2010analysis (NMA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2010important outcomes, we performed frequentist NMAs separately for RCTs and observational studies with adjusted analyses, and assessed the certainty of evidence using the GRADE framework.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 5156 publications identified, we included 7 RCTs and 12 observational studies, and report on two contemporarily\u2010used IT agents\u2014basiliximab 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\u2010day (OR 1.13; 95% CI 1.06\u20131.20) and 1\u2010year (OR 1.11; 95% CI 1.02\u20131.22) mortality compared to no IT. With low certainty from observational studies, rATG may decrease 5\u2010year cardiac allograft vasculopathy (OR\u00a0.82; 95% CI\u00a0.74\u2013.90) compared to no IT, as well as 30\u2010day (OR\u00a0.85; 95% CI\u00a0.80\u2013.92), 1\u2010year (OR\u00a0.87; 95% CI\u00a0.79\u2013.96), and overall (HR\u00a0.84; 95% CI\u00a0.76\u2013.93) mortality compared to basiliximab.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.15326","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T10:40:25Z","timestamp":1715164825000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Induction therapy in heart transplantation: A systematic review and network meta\u2010analysis for developing evidence\u2010based recommendations"],"prefix":"10.1111","volume":"38","author":[{"given":"Lakshmi","family":"Kugathasan","sequence":"first","affiliation":[{"name":"Ted Rogers Centre for Heart Research University Health Network  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel G","family":"Rayner","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods Evidence, and Impact, McMaster  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina Mianchen","family":"Wang","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Rodenas\u2010Alesina","sequence":"additional","affiliation":[{"name":"Ted Rogers Centre for Heart Research University Health Network  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ani","family":"Orchanian\u2010Cheff","sequence":"additional","affiliation":[{"name":"Toronto General Hospital University Health Network  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7362-0513","authenticated-orcid":false,"given":"Josef","family":"Stehlik","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiovascular Medicine University of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finn","family":"Gustafsson","sequence":"additional","affiliation":[{"name":"Rigshospitalet \u2010 Copenhagen University Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Greig","sequence":"additional","affiliation":[{"name":"Pontificia Universidad Cat\u00f3lica de Chile  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"McDonald","sequence":"additional","affiliation":[{"name":"Ted Rogers Centre for Heart Research University Health Network  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro Mario","family":"Bertolotti","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery Department Favaloro Foundation University hospital  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penny","family":"Demas\u2010Clarke","sequence":"additional","affiliation":[{"name":"Toronto General Hospital University Health Network  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Kozuszko","sequence":"additional","affiliation":[{"name":"Ted Rogers Centre for Heart Research University Health Network  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon","family":"Guyatt","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods Evidence, and Impact, McMaster  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1029-1812","authenticated-orcid":false,"given":"Farid","family":"Foroutan","sequence":"additional","affiliation":[{"name":"Ted Rogers Centre for Heart Research University Health Network  Toronto Ontario Canada"},{"name":"Department of Health Research Methods Evidence, and Impact, McMaster  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2744-2696","authenticated-orcid":false,"given":"Ana Carolina","family":"Alba","sequence":"additional","affiliation":[{"name":"Ted Rogers Centre for Heart Research University Health Network  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2014.08.003"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000149745.83186.89"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.2147\/TRRM.S36734"},{"issue":"3","key":"e_1_2_9_5_1","first-page":"319","article-title":"Thymoglobulin\u2013new approaches to optimal outcomes","volume":"2","author":"Moicean AD","year":"2009","journal-title":"J Med Life"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2010.01.018"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2006.09.002"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2007.01.006"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2007.05.002"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2004.09.010"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.029753"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2016.08.017"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008842.pub2"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2008.05.013"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741\u2010018\u20109691\u20102"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2019.08.012"},{"key":"e_1_2_9_20_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022)","author":"Higgins JPT"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2021.12.011"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2018.11.025"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m3900"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2021.07.011"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2019.12.025"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2010.05.034"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.15270"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2018.07.022"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2022.01.008"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2020.11.021"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14440"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2004.01.002"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.17130"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13651"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.15326","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T08:03:33Z","timestamp":1716537813000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.15326"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5]]},"references-count":33,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1111\/ctr.15326"],"URL":"https:\/\/doi.org\/10.1111\/ctr.15326","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5]]},"assertion":[{"value":"2024-02-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e15326"}}