What is the most appropriate induction immunosuppression approach for a patient with hereditary nonischemic dilated cardiomyopathy who has a TITIN mutation and a high cPRA?

The most appropriate induction immunosuppression approach in this case involves the use of antithymocyte globulin. This choice is particularly relevant for patients with a high calculated panel-reactive antibody (cPRA), which indicates a high risk of alloimmunization in the context of organ transplantation. Antithymocyte globulin is a polyclonal rabbit immunoglobulin that is effective in depleting T cells, which plays a critical role in preventing acute rejection and managing sensitization in transplant recipients.

Patients with high levels of sensitization, such as those with a high cPRA, benefit from a more aggressive induction regimen to minimize the risk of acute rejection and optimize transplant outcomes. Antithymocyte globulin not only helps in reducing T-cell mediated immunity but also provides a degree of long-term immunosuppression, which can be highly beneficial in this specific scenario.

In contrast, the other options do not suit the complexities presented by the patient. Basiliximab is a monoclonal antibody that targets the IL-2 receptor and is typically used in lower-risk patients, but it may not sufficiently prevent rejection in a sensitized individual. No induction does not provide adequate immunosuppression for a patient with a TITIN mutation