title: Induction therapy with interleukin-2 receptor antagonist after intestinal transplantation is associated with reduced acute cellular rejection and improved renal function.
abstract: OBJECTIVE
  To determine the effectiveness of induction immunotherapy with interleukin-2 receptor antagonists (IL2RA) after intestinal transplantation (IT).
  
  
  METHODS
  A single-center, retrospective study was undertaken of all patients undergoing IT using existing medical records and database. Immunotherapy was either triple (standard maintenance triple therapy [SMTT]) or IL2RA [induction IL2RA plus SMTTx] or OKT3 [induction antilymphocyte preparations plus SMTTx]). Data was collected for the first 175 postoperative days. Outcomes included pretransplant renal function, posttransplant serum creatinine normalized to age (nl-sCR), rejection (ACR), and survival. Standard statistical analysis was undertaken.
  
  
  RESULTS
  There were no significant differences in the groups: triple (n = 10, median age 3.5 years, cGFR 106 +/- 44 mL/min), IL2RA (n = 13, median age 3.2 years, cGFR 101 +/- 61 mL/min), OKT3 (n = 4, median age 7.7 years, cGFR 104 +/- 27 mL/min). nl-sCR was significantly (P <.01) lower in IL2RA at most postoperative weeks. IL2RA had significantly fewer rejection and infectious episodes than the other two groups. Three-year patient survival was 92% in IL2RA versus 50% triple and OKT3.
  
  
  CONCLUSIONS
  IL2RA immunotherapy after IT is associated with a lower incidence of renal dysfunction as compared with historical controls. Furthermore, IL2RA therapy resulted in a lower incidence of rejection and improved survival. IL2RA should be considered in select patients undergoing IT.
authors.affiliation: Dumont-UCLA Transplant Program, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. dgfarmer@mednet.ucla.edu
authors.forename: D G
authors.initials: DG
authors.lastname: Farmer
authors.forename: S V
authors.initials: SV
authors.lastname: McDiarmid
authors.forename: S
authors.initials: S
authors.lastname: Edelstein
authors.forename: J F
authors.initials: JF
authors.lastname: Renz
authors.forename: G
authors.initials: G
authors.lastname: Hisatake
authors.forename: G
authors.initials: G
authors.lastname: Cortina
authors.forename: C
authors.initials: C
authors.lastname: Fondevila
authors.forename: M
authors.initials: M
authors.lastname: Correa
authors.forename: S
authors.initials: S
authors.lastname: Rhodes
authors.forename: A
authors.initials: A
authors.lastname: Zafar
authors.forename: Y
authors.initials: Y
authors.lastname: Chavez
authors.forename: H
authors.initials: H
authors.lastname: Yersiz
authors.forename: R W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D002648:Child; D002675:Child, Preschool; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016853:Muromonab-CD3 / Q000627:therapeutic use; D015375:Receptors, Interleukin-2 / Q000037:antagonists & inhibitors*; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D015375:Receptors, Interleukin-2