Interleukin 2 receptor antagonists for kidney transplant recipients

Abstract

Given a 40% risk of rejection, seven patients would need treatment with IL2Ra to prevent one patient having rejection, with no definite improvement in graft or patient survival. There is no apparent difference between basiliximab and daclizumab. IL2Ra are as effective as other antibody therapies and with significantly fewer side effects

Induction immunosuppression and the risk of incident malignancies among older and younger kidney transplant recipients: A prospective cohort study

“…Consistent with previous studies, 25–29 we observed an increased risk of malignancies associated with the use of ATG induction. In a Cochrane systematic review, 25 Webster et al collected information from 18 studies and concluded that the use of IL‐2RA induction during KT could reduce the risk of post‐KT malignancy (RR = 0.25, 95%CI: 0.07–0.87) compared with ATG, while appeared no significant difference in terms of other vital clinical outcomes, including death, graft loss, and clinically diagnosed acute rejection.…”

“…Consistent with previous studies, 25–29 we observed an increased risk of malignancies associated with the use of ATG induction. In a Cochrane systematic review, 25 Webster et al collected information from 18 studies and concluded that the use of IL‐2RA induction during KT could reduce the risk of post‐KT malignancy (RR = 0.25, 95%CI: 0.07–0.87) compared with ATG, while appeared no significant difference in terms of other vital clinical outcomes, including death, graft loss, and clinically diagnosed acute rejection. Other reports found an increased risk associated with ATG induction compared with no induction in different types of post‐KT malignancy, ranging from 1.5‐fold elevated risk in melanoma (Hall et al) to 1.78‐fold in post‐transplant lymphoproliferative disorder (Bustami et al) 26,28,29 …”

“…In this national study of 66 770 adult KT recipients, we found that recipients who received ATG induction, as compared with those F I G U R E 3 Estimated risk (hazard ratio) of (a) any post-kidney transplant malignancy and (b) any post-kidney transplant malignancy excluding non-melanoma skin cancer of adult recipients (n = 770) by recipient age. Age at the time of transplant treating as continuous risk factor for this analysis Consistent with previous studies, [25][26][27][28][29] . 26,28,29 Our study built upon previous studies [30][31][32]…”

Induction immunosuppression and the risk of incident malignancies among older and younger kidney transplant recipients: A prospective cohort study

“…Consistent with previous studies, 25–29 we observed an increased risk of malignancies associated with the use of ATG induction. In a Cochrane systematic review, 25 Webster et al collected information from 18 studies and concluded that the use of IL‐2RA induction during KT could reduce the risk of post‐KT malignancy (RR = 0.25, 95%CI: 0.07–0.87) compared with ATG, while appeared no significant difference in terms of other vital clinical outcomes, including death, graft loss, and clinically diagnosed acute rejection.…”

“…Consistent with previous studies, 25–29 we observed an increased risk of malignancies associated with the use of ATG induction. In a Cochrane systematic review, 25 Webster et al collected information from 18 studies and concluded that the use of IL‐2RA induction during KT could reduce the risk of post‐KT malignancy (RR = 0.25, 95%CI: 0.07–0.87) compared with ATG, while appeared no significant difference in terms of other vital clinical outcomes, including death, graft loss, and clinically diagnosed acute rejection. Other reports found an increased risk associated with ATG induction compared with no induction in different types of post‐KT malignancy, ranging from 1.5‐fold elevated risk in melanoma (Hall et al) to 1.78‐fold in post‐transplant lymphoproliferative disorder (Bustami et al) 26,28,29 …”

“…In this national study of 66 770 adult KT recipients, we found that recipients who received ATG induction, as compared with those F I G U R E 3 Estimated risk (hazard ratio) of (a) any post-kidney transplant malignancy and (b) any post-kidney transplant malignancy excluding non-melanoma skin cancer of adult recipients (n = 770) by recipient age. Age at the time of transplant treating as continuous risk factor for this analysis Consistent with previous studies, [25][26][27][28][29] . 26,28,29 Our study built upon previous studies [30][31][32]…”

Daclizumab Versus Rabbit Antithymocyte Globulin in High-Risk Renal Transplants: Five-Year Follow-up of a Randomized Study

“…With regard to safety, rATG has historically been associated with an increased risk of infection or malignancy compared to IL‐2Ra . However, we did not observe any difference in 5‐year patient survival, nor any suggestion of increased mortality from infection or malignancy in the rATG arm.…”

Long-term outcome of belatacept therapy in de novo kidney transplant recipients - a case-match analysis

“…We observed substantially more BPAR within 6 months in patients treated primarily with CyA compared with the study group, which is probably related to the fact that induction therapy was not standard of practice at our center at that time . The rejection rate in the belatacept group was lower than the range observed in the BENEFIT trial (17–22%), but higher than the ones seen in the phase II trial (6–7%).…”

Induction immunosuppression and the risk of incident malignancies among older and younger kidney transplant recipients: A prospective cohort study

“…Consistent with previous studies, 25–29 we observed an increased risk of malignancies associated with the use of ATG induction. In a Cochrane systematic review, 25 Webster et al collected information from 18 studies and concluded that the use of IL‐2RA induction during KT could reduce the risk of post‐KT malignancy (RR = 0.25, 95%CI: 0.07–0.87) compared with ATG, while appeared no significant difference in terms of other vital clinical outcomes, including death, graft loss, and clinically diagnosed acute rejection.…”

“…Consistent with previous studies, 25–29 we observed an increased risk of malignancies associated with the use of ATG induction. In a Cochrane systematic review, 25 Webster et al collected information from 18 studies and concluded that the use of IL‐2RA induction during KT could reduce the risk of post‐KT malignancy (RR = 0.25, 95%CI: 0.07–0.87) compared with ATG, while appeared no significant difference in terms of other vital clinical outcomes, including death, graft loss, and clinically diagnosed acute rejection. Other reports found an increased risk associated with ATG induction compared with no induction in different types of post‐KT malignancy, ranging from 1.5‐fold elevated risk in melanoma (Hall et al) to 1.78‐fold in post‐transplant lymphoproliferative disorder (Bustami et al) 26,28,29 …”

“…In this national study of 66 770 adult KT recipients, we found that recipients who received ATG induction, as compared with those F I G U R E 3 Estimated risk (hazard ratio) of (a) any post-kidney transplant malignancy and (b) any post-kidney transplant malignancy excluding non-melanoma skin cancer of adult recipients (n = 770) by recipient age. Age at the time of transplant treating as continuous risk factor for this analysis Consistent with previous studies, [25][26][27][28][29] . 26,28,29 Our study built upon previous studies [30][31][32]…”

Daclizumab Versus Rabbit Antithymocyte Globulin in High-Risk Renal Transplants: Five-Year Follow-up of a Randomized Study

“…With regard to safety, rATG has historically been associated with an increased risk of infection or malignancy compared to IL‐2Ra . However, we did not observe any difference in 5‐year patient survival, nor any suggestion of increased mortality from infection or malignancy in the rATG arm.…”

Long-term outcome of belatacept therapy in de novo kidney transplant recipients - a case-match analysis

“…We observed substantially more BPAR within 6 months in patients treated primarily with CyA compared with the study group, which is probably related to the fact that induction therapy was not standard of practice at our center at that time . The rejection rate in the belatacept group was lower than the range observed in the BENEFIT trial (17–22%), but higher than the ones seen in the phase II trial (6–7%).…”

Induction immunosuppression and the risk of incident malignancies among older and younger kidney transplant recipients: A prospective cohort study

“…Consistent with previous studies, 25–29 we observed an increased risk of malignancies associated with the use of ATG induction. In a Cochrane systematic review, 25 Webster et al collected information from 18 studies and concluded that the use of IL‐2RA induction during KT could reduce the risk of post‐KT malignancy (RR = 0.25, 95%CI: 0.07–0.87) compared with ATG, while appeared no significant difference in terms of other vital clinical outcomes, including death, graft loss, and clinically diagnosed acute rejection.…”

“…Consistent with previous studies, 25–29 we observed an increased risk of malignancies associated with the use of ATG induction. In a Cochrane systematic review, 25 Webster et al collected information from 18 studies and concluded that the use of IL‐2RA induction during KT could reduce the risk of post‐KT malignancy (RR = 0.25, 95%CI: 0.07–0.87) compared with ATG, while appeared no significant difference in terms of other vital clinical outcomes, including death, graft loss, and clinically diagnosed acute rejection. Other reports found an increased risk associated with ATG induction compared with no induction in different types of post‐KT malignancy, ranging from 1.5‐fold elevated risk in melanoma (Hall et al) to 1.78‐fold in post‐transplant lymphoproliferative disorder (Bustami et al) 26,28,29 …”

“…In this national study of 66 770 adult KT recipients, we found that recipients who received ATG induction, as compared with those F I G U R E 3 Estimated risk (hazard ratio) of (a) any post-kidney transplant malignancy and (b) any post-kidney transplant malignancy excluding non-melanoma skin cancer of adult recipients (n = 770) by recipient age. Age at the time of transplant treating as continuous risk factor for this analysis Consistent with previous studies, [25][26][27][28][29] . 26,28,29 Our study built upon previous studies [30][31][32]…”

Daclizumab Versus Rabbit Antithymocyte Globulin in High-Risk Renal Transplants: Five-Year Follow-up of a Randomized Study

“…With regard to safety, rATG has historically been associated with an increased risk of infection or malignancy compared to IL‐2Ra . However, we did not observe any difference in 5‐year patient survival, nor any suggestion of increased mortality from infection or malignancy in the rATG arm.…”

Long-term outcome of belatacept therapy in de novo kidney transplant recipients - a case-match analysis

“…We observed substantially more BPAR within 6 months in patients treated primarily with CyA compared with the study group, which is probably related to the fact that induction therapy was not standard of practice at our center at that time . The rejection rate in the belatacept group was lower than the range observed in the BENEFIT trial (17–22%), but higher than the ones seen in the phase II trial (6–7%).…”