Interleukin-2 receptor antagonists and aggressive steroid minimization strategies for kidney transplant patients.
Steroid withdrawal during the first week after transplantation surgery, or complete avoidance of steroids, offers potential benefits. The interleukin-2 (IL-2) receptor antibodies, basiliximab and daclizumab, can enable aggressive steroid minimization protocols that are efficacious while reducing toxicity. A multicenter, randomized trial of kidney transplant recipients has shown the incidence of biopsy-proven acute rejection with basiliximab, cyclosporine and mycophenolate mofetil with steroids withdrawn at day 5 to be similar to a conventional triple-therapy regimen. A single perioperative dose of corticosteroids with an IL-2 receptor antagonist also seems as efficacious as standard steroid therapy. Corticosteroid-minimization with IL-2 receptor antagonists has also been investigated with sirolimus-containing regimens and has shown excellent outcomes. Experience with complete steroid avoidance, using an IL-2 receptor antagonist, is limited, but initial results are promising, particularly in pediatric patients. Administration of an IL-2 receptor antagonist with aggressive steroid minimization in selected, well-monitored patients seems reasonable, but further trials are required to define optimal protocols.
Vincenti
Flavio
F
Kidney Transplant Service, University of California-San Francisco, 505 Parnassus, Box 0116, San Francisco, CA 94143, USA. VincentiF@surgery.ucsf.edu
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D015375:Receptors, Interleukin-2 / Q000037:antagonists & inhibitors*
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2