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

Am J Nephrol. 2021;52(4):279-291. doi: 10.1159/000514454. Epub 2021 Apr 22.

Abstract

Introduction: 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.

Methods: 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).

Results: In group A, 11 studies were included (n = 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 (n = 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).

Conclusion: IL2-RA induction therapy does not improve outcomes in patients maintained on tacrolimus-based immunotherapy in standard-risk population.

Keywords: Interleukin-2 receptor antagonist; Kidney transplant recipient; Mycophenolate mofetil; Panel-reactive antibody.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Induction Chemotherapy
  • Kidney Transplantation*
  • Maintenance Chemotherapy
  • Receptors, Interleukin-2 / antagonists & inhibitors*
  • Risk Assessment
  • Tacrolimus / therapeutic use*
  • Treatment Outcome

Substances

  • Immunosuppressive Agents
  • Receptors, Interleukin-2
  • Tacrolimus