Outcomes of Interleukin-2 Receptor Antagonist Induction Therapy in Standard-Risk Renal Transplant Recipients Maintained on Tacrolimus: A Systematic Review and Meta-Analysis

Abstract

<b><i>Introduction:</i></b> The additive benefit of interleukin-2 receptor antagonist (IL2-RA) induction in standard-risk kidney transplant recipients, while maintained on tacrolimus-based immunosuppressive therapy, is uncertain. <b><i>Methods:</i></b> We divided the studies included in this meta-analysis into 2 groups: group A (included studies that used same dose of tacrolimus in both arms of each study) and group B (included studies that compared patients who received induction therapy and low-dose tacrolimus vs. those who received no-induction therapy and high dose of tacrolimus). <b><i>Results:</i></b> In group A, 11 studies were included (<i>n</i> = 2,886). IL2-RA induction therapy was not associated with significant differences in comparison to no-induction therapy in terms of acute rejection rates at 6 months post-transplant (risk ratio = 1.12 and 95% confidence interval [CI] range: 0.94–1.35) or graft survival at 1 year post-transplant (risk ratio = 0.78 and 95% CI range: 0.45–1.36). In group B, 2 studies were included (<i>n</i> = 669). There was no difference between both arms in terms of acute rejection rates (risk ratio = 0.62, with 95% CI range: 0.33–1.14) or graft survival (risk ratio = 1 and 95% CI range: 0.57–1.74). <b><i>Conclusion:</i></b> IL2-RA induction therapy does not improve outcomes in patients maintained on tacrolimus-based immunotherapy in standard-risk population.

Basiliximab induction versus no induction in adult heart transplantation

“…However, in more recent studies utilizing modern immunosuppression, IL2RA induction has not demonstrated similar benefits compared to no induction. IL2RA induction was not associated with a rejection benefit at 6 months or graft survival benefit at 1‐year in a large meta‐analysis 18 . Similarly, a registry analysis using data from the British Renal Transplant Registry did not find that IL2RA induction affected eGFR or graft outcomes at 1‐year 19 …”

“…IL2RA induction was not associated with a rejection benefit at 6 months or graft survival benefit at 1-year in a large meta-analysis. 18 Similarly, a registry analysis using data from the British Renal Transplant Registry did not find that IL2RA induction affected eGFR or graft outcomes at 1-year. 19 Our study also examined only low immunologic risk patients.…”

Outcomes of thymoglobulin versus basiliximab induction therapies in living donor kidney transplant recipients with mild to moderate immunological risk – a retrospective analysis of UNOS database

“…Moreover, there was significant difference in PRA levels between basiliximab and thymoglobulin groups. However, the PRA levels in both groups were less than 10%, which is considered as the cut-off for standard immunological risk transplants in most of the literature [ 5 , 9 ]. In addition, we included patients with no previous transplants in our study.…”

“…Furthermore, there was a statistical difference between both induction groups in terms of donor age. However, from the clinical point of view, both ages (44.73 in the thymoglobulin group and 47.82 in the basiliximab group) are very similar and do not meet the criteria for expanded criteria donor [ 5 , 13 ]. Our results reflect that selection of living donors with age less than 50 leads to acceptable transplant outcomes irrespective of HLA mismatching.…”

“…Crossmatch incompatibility for a patient with an 80% PRA would be with 80% of donors. A calculated PRA of 20% has been used as a cut-off point for mild immunological risk by many transplant centres [ 5 , 6 ]. A combination of HLA mismatch and C-PRA can be used to assess the immunological risk in transplant.…”