<h3>Purpose</h3> Induction therapy provides, when the risk of allograft rejection is the highest, early intense immunosuppression. Whether to use induction therapy, and the choice of optimal regimen remains controversial. Our goal is to develop a clinical practice guideline for the use of induction therapy (IT) in the heart transplant (HT) setting. <h3>Methods</h3> We recruited a worldwide multidisciplinary panel free of financial and intellectual conflicts of interest made up of three patient partners, five cardiologists, two surgeons, one nurse practitioner, one pharmacist, two guideline methodologists, and one systematic reviewer. This panel will use the GRADE framework and follow the standards for trustworthy guideline development, in compliance with Institute of Medicine and the Guideline International Network. Through consideration of balance between benefits and harms, quality of the evidence, and patient's values and preferences, the panel will make strong or weak recommendations for or against the use of the currently available IT agents. The panel has held its first meeting at which it finalized the guideline question as: Which aspects of IT should be used in adult HT recipients in the early post-operative period? The panel determined that to answer this question, knowledge of the impact of IT on the following outcomes is critical: all-cause mortality, re-transplant, rate of treated rejection (cellular and antibody-mediated), graft dysfunction (heart failure symptoms), infections and need for dialysis. The panel assessed the following as further important outcomes: length of hospital stay, post-surgical bleeding, risk of cancer, and quality of life. The panel's assessment of outcome importance was similar whether the time-frame was early (within the first-year) or late post-transplant. The panel will meet two further times during a timeframe of 6 months: once to review the evidence synthesized by the systematic review and a second time to develop recommendations including their direction and strength for or against the use of specific aspects of IT. <h3>Endpoints</h3> Our recommendations will be based on the perspective of patients. We have already begun a systematic review and network meta-analysis on all agents used for IT. The results of this review will inform our panel in making their final recommendations by February 28<sup>th</sup>, 2022.
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