The impact of IL2ra induction therapy in kidney transplantation using tacrolimus- and mycophenolate-based immunosuppression

Transplantation. 2010 Sep 27;90(6):639-44. doi: 10.1097/TP.0b013e3181ea6788.

Abstract

Background: IL2 receptor antagonist (IL2ra) induction therapy has gained favor due to an excellent safety profile and improved outcomes in randomized trials using cyclosporine-based immunosuppression. However, there have been no large randomized trials or retrospective analyses examining the effect of IL2ra versus no induction using tacrolimus and mycophenolate (TAC/MPA)-based therapy.

Methods: A retrospective analysis from the Scientific Renal Transplant Registry of adult, primary kidney transplant recipients from 2000 to 2008 with initial immunosuppression of TAC/MPA and prednisone, who received IL2ra induction therapy or no induction therapy (n=28,686) was performed. The primary outcome was acute rejection at 1 year, and secondary outcomes were graft and patient survival at 1 and 3 years. Multivariable analysis was used to control for factors shown to influence the incidence of acute rejection, and separate analyses were performed for deceased versus living donors.

Results: Acute rejection at 1 year was significantly lower with IL2ra (11.6%) versus no induction therapy (13.0%; P=0.001). One-year (95.7% vs. 95.8%) and 3-year (87.5% vs. 87.8%) graft survival, and 1-year (97.4% vs. 97.5%) and 3-year (92.8% vs. 93.2%) patient survival, was not different between those receiving IL2ra and no induction therapy. On multivariable analysis, the relative risk of acute rejection with IL2ra was 0.90 (95% CI, 0.85-0.96; P=0.001), and the effect was greater in living donors (relative risk, 0.82; P<0.001) than deceased donors (relative risk, 0.95; P=0.23).

Conclusion: The benefit of IL2ra induction with TAC/MPA/prednisone maintenance immunosuppression is less than previously reported due to a low baseline incidence of acute rejection.

MeSH terms

  • Adult
  • Cadaver
  • Cohort Studies
  • Female
  • Graft Rejection / epidemiology
  • Graft Rejection / prevention & control
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Interleukin-2 Receptor alpha Subunit / therapeutic use*
  • Kidney Transplantation / immunology
  • Kidney Transplantation / physiology*
  • Living Donors
  • Male
  • Middle Aged
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Prednisone / therapeutic use
  • Registries
  • Retrospective Studies
  • Tacrolimus / therapeutic use
  • Tissue Donors

Substances

  • IL2RA protein, human
  • Immunosuppressive Agents
  • Interleukin-2 Receptor alpha Subunit
  • Mycophenolic Acid
  • Prednisone
  • Tacrolimus