It's Time for Personalized Medicine in Cardiac Transplantation; One Size Does Not Fit All

Does the approach of “one size fits all” apply to induction and immunosuppression in cardiac transplantation make sense? For example, does a 68 year old Caucasian male with 0% panel reactive antibodies with a left ventricular assist device (LVAD) and a driveline infection get the same induction and maintenance therapy as a 25 year old African-American female with multiple pregnancies and 85% panel reactive antibodies? Many centers the answer would be yes and we need to change this archaic way of practicing transplant medicine. There is a delicate balance between rejection and infection and with each patient that balance must be maximized. When looking at the 2015 International Society of Heart and Lung Transplant registry, approximately 50% of programs administer no induction therapy, another 25% administer intravenous basiliximab and another 25% percent administer intravenous thymoglobulin. This trend hasn’t changed in several years. The method that is used is program specific and to be honest, reminds me of the times of the “Wild West”. I have had the luxury of training at 3 different sites and have been an attending at one institution and each program does it differently. We have data to suggest maybe personalized medicine is not such a bad idea. In fact, in 2012 the transplant groups from Johns Hopkins and Yale published in Circulation a 13 point score to help predict rejection after cardiac transplantation