Induction Therapy for Kidney Transplant Recipients: Do We Still Need Anti-IL2 Receptor Monoclonal Antibodies?

Hellemans, Rachel; Bosmans, Johan; Abramowicz, Daniel

doi:10.1111/ajt.13884

Cited by 75 publications

(53 citation statements)

References 35 publications

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“…20 The frequency of patients who Previous reports demonstrated that ABO-ILKT is more cost-effective than ABO-CLKT. 25 In Japan, the use of induction with basiliximab is now common in both ABO-CLKT and ABO-ILKT, because induction with basiliximab led to a substantial reduction in early acute rejection in the previous era. One Recently, the role of basiliximab in ABO-CLKT has become questionable because it may no longer be beneficial in standard-risk transplantation.…”

Section: However Abo-ilkt Remains Much Less Common In the Unitedmentioning

confidence: 99%

“…7,10,18,24 In this study, Recently, the role of basiliximab in ABO-CLKT has become questionable because it may no longer be beneficial in standard-risk transplantation. 25 In Japan, the use of induction with basiliximab is now common in both ABO-CLKT and ABO-ILKT, because induction with basiliximab led to a substantial reduction in early acute rejection in the previous era. However, with widespread use of tacrolimus and MMF combination therapy conferring a lower baseline acute rejection risk, the benefit of induction with basiliximab has become questionable in standard-risk transplantation, such as non-sensitized ABO-CLKT.…”

Section: However Abo-ilkt Remains Much Less Common In the Unitedmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes, complications, and economic impact of ABO‐incompatible living kidney transplantation: A single‐center Japanese cohort study

Kakuta

Okumi

Unagami

et al. 2019

Clinical Transplantation

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| INTRODUC TI ONABO-incompatible living kidney transplantation (ABO-ILKT) was initially considered to result in antibody-mediated rejection (ABMR) leading to graft loss. In 1987, however, successful ABO-ILKT was introduced in Japan, using pre-transplant antibody depletion. [1][2][3][4] Recently, ABO-ILKT has been performed as a routine practice and constituted nearly 30% of living kidney transplantation performed in Japan. The substantial improvements of ABO-ILKT were demonstrated in relation to the graft survival rate, the frequency of infectious adverse events, and renal function over time. We previously reported that the graft survival of patients who underwent LKT in the past decade was almost identical regardless of ABO incompatibility. 5 Abstract ABO-incompatible kidney transplantation (ABO-ILKT) has been reported to have a higher rate of early complications and higher medical costs than ABO-compatible kidney transplantation (ABO-CLKT). We aimed to compare the clinical outcomes, complications, and medical costs between ABO-ILKTs and ABO-CLKTs at 2 years post-transplantation. We included 65 ABO-ILKTs and 94 ABO-CLKTs in this retrospective analysis. The patient survival, graft survival, rejection incidence, and graft function were similar between ABO-CLKT and ABO-ILKT. The hospitalization costs for ABO-CLKT and ABO-ILKT were 26 544 ± 4168 USD and 34 906 ± 18 732 USD, respectively (P = 0.0001). Total 2-year medical costs were 77 117 ± 15 609 USD and 85 325 ± 33 997 USD for ABO-CLKT and ABO-ILKT, respectively, indicating that the medical costs of ABO-ILKT recipients were non-significantly higher than those of ABO-CLKT recipients at 2 years post-transplantation (P = 0.0866). ABO-ILKT and ABO-CLKT recipients showed similar infectious adverse events and complications. In conclusion, medical cost at 2 years post-transplantation, including transplant hospitalization cost, and the frequency of early complications were not significantly higherin the ABO-ILKT group than in the ABO-CLKT group. ABO-ILKT is an acceptable treatment for patients with ESRD and is comparable to ABO-CLKT not only in terms of outcomes but also in terms of medical cost.

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Section: However Abo-ilkt Remains Much Less Common In the Unitedmentioning

confidence: 99%

Section: However Abo-ilkt Remains Much Less Common In the Unitedmentioning

confidence: 99%

Outcomes, complications, and economic impact of ABO‐incompatible living kidney transplantation: A single‐center Japanese cohort study

Kakuta

Okumi

Unagami

et al. 2019

Clinical Transplantation

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“…1,2 Induction immunosuppression has traditionally included T cell-depleting or non-T cell-depleting therapy. 1,2 Induction immunosuppression has traditionally included T cell-depleting or non-T cell-depleting therapy.…”

Section: Introductionmentioning

confidence: 99%

“…Induction immunosuppressive therapy in kidney transplantation is used to reduce the incidence and severity of acute rejection, delay the initiation of calcineurin inhibitors, and/or facilitate minimization of maintenance corticosteroid or calcineurin inhibitor therapy. 1,2 Induction immunosuppression has traditionally included T cell-depleting or non-T cell-depleting therapy. [3][4][5] Before the approval of rabbit anti-thymocyte globulin [rATG] in 2017, the non-T-cell-depleting monoclonal interleukin-2 (IL-2) receptor antagonists (IL2RAs) basiliximab and daclizumab (the latter was removed from the market in 2009) represented the only Food and Drug Administration (FDA)-approved induction agents for kidney transplant in the United States.…”

Section: Introductionmentioning

confidence: 99%

Rabbit anti-thymocyte globulin for the prevention of acute rejection in kidney transplantation

Alloway

Woodle

Abramowicz

et al. 2019

American Journal of Transplantation

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This report describes the results of 2 international randomized trials (total of 508 kidney transplant recipients). The primary objective was to assess the noninferiority of rabbit anti‐thymocyte globulin (rATG, Thymoglobulin®) versus interleukin‐2 receptor antagonists (IL2RAs) for the quadruple endpoint (treatment failure defined as biopsy‐proven acute rejection, graft loss, death, or loss to follow‐up) to serve as the pivotal data for United States (US) regulatory approval of rATG. The pooled analysis provided an incidence of treatment failure of 25.1% in the rATG and 36.0% in the IL2RA treatment groups, an absolute difference of −10.9% (95% confidence interval [CI] −18.8% to −2.9%) supporting noninferiority (noninferiority margin was 10%) and superiority of rATG to IL2RA. In a meta‐analysis of 7 trials comparing rATG with an IL2RA, the difference in the proportion of patients with BPAR at 12 months was −4.8% (95% CI −8.6% to −0.9%) in favor of rATG. In conclusion, a rigorous reanalysis of patient‐level data from 2 prior randomized, controlled trials comparing rATG versus IL‐2R monoclonal antibodies provided support for regulatory approval for rATG for induction therapy in renal transplant, making it the first T cell–depleting therapy approved for the prophylaxis of acute rejection in patients receiving a kidney transplant in the United States.

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“…In comparing IL2RA and no induction, rejection rates are dismissed, with a focus on the lack of differences in patient or graft survival. In contrast, in comparing IL2RA and rabbit-derived antithymocyte globulin (RATG), the lack of long-term differences in patient or graft survival was minimized, and acute rejection was instead the focus (1).…”

mentioning

confidence: 99%

Yes, We Still Need IL-2 Receptor Antagonists

Fleming

Taber

Pilch

et al. 2016

American Journal of Transplantation

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Induction Therapy for Kidney Transplant Recipients: Do We Still Need Anti-IL2 Receptor Monoclonal Antibodies?

Cited by 75 publications

References 35 publications

Outcomes, complications, and economic impact of ABO‐incompatible living kidney transplantation: A single‐center Japanese cohort study

Outcomes, complications, and economic impact of ABO‐incompatible living kidney transplantation: A single‐center Japanese cohort study

Rabbit anti-thymocyte globulin for the prevention of acute rejection in kidney transplantation

Yes, We Still Need IL-2 Receptor Antagonists

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