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Ali H, Mohamed M, Sharma A, Fulop T, Halawa A: Outcomes of Interleukin-2 Receptor Antagonist Induction Therapy in Standard-Risk Renal Transplant Recipients Maintained on Tacrolimus: A Systematic Review and Meta-Analysis. American Journal of Nephrology DOI 10.1159/000514454
The short-term benefits (1–3 years) attending the routine use of induction adjuvant therapy with interleukin-2 (IL-2) receptor antagonists (basiliximab or daclizumab) in standard-risk kidney allograft recipients treated with conventional tacrolimus/mycophenolate mofetil/corticosteroid regimens is uncertain.
Ali and coworkers addressed this issue by conducting a systematic review and meta-analysis of reported prospective randomized clinical trials examining the effects of IL-2 receptor antagonists in standard-risk allograft recipients treated with tacrolimus-based regimens. Two groups were analyzed: (a) the same dose of tacrolimus in both arms of the trial (n = 2,886); (b) IL-2 receptor antagonists + low-dose tacrolimus versus no IL-2 receptor antagonists and high-dose tacrolimus (n = 669). No benefits for the “hard” endpoints of graft or patient survival were seen for IL-2 receptor antagonism use at 1 year of follow-up.
This analysis represents an important addition to the literature on pharmacotherapy for the prevention of allograft rejection leading to early graft loss. The analysis was carried out with rigorous attention to recommendations for such systematic reviews. The subjects examined were “standard risk” and the results may not apply to “high-risk” patients, such as sensitized patients or second kidney allografts. The dearth of Black recipients prevented any analysis of ancestry-related factors in determining outcomes. The short-term nature of the analyses prevented examination of other clinically important differences that are delayed, such as malignancy risk, chronic allograft nephropathy, and calcineurin inhibitor-associated nephrotoxicity. Nevertheless, it does appear that there are no compelling short-term advantages of use of adjuvant IL-2 receptor antagonism in patients receiving tacrolimus-based conventional post-transplant immunosuppression. It is unclear whether a slightly better eGFR at 1 year in the group B subjects receiving IL-2 receptor induction therapy and low-dose tacrolimus will be predictive of better long-term outcomes. No transplant kidney biopsy data were included in this analysis. This needs to be corrected by future studies as morphology in early transplant kidney biopsies may predict longer-term graft outcomes. However, the analysis suggests that omission of the use of IL-2 receptor antagonism might be considered in “standard-risk” patients when tacrolimus-based regimens are employed for the prevention of kidney allograft rejection.
