Anti-IL-2 receptor antibody vs. polyclonal anti-lymphocyte antibody as induction therapy in pediatric transplantation.
Current concerns in pediatric transplantation focus on chronic rejection which commonly leads to graft loss, and on long-term maintenance immunosuppression toxicity. Acute rejection has been associated with the subsequent development of chronic rejection. Therefore, induction therapy may provide potential benefits by preventing early acute rejection episodes and allowing delayed administration of calcineurin inhibitors or steroid avoidance. This review of the literature showed that induction therapy can reduce early and recurrent acute rejection episodes after pediatric solid organ transplantation. Whether this might result in better long-term graft survival has still to be confirmed. However, induction therapy has beneficial effects in high-risk recipients and allows steroid avoidance or calcineurin inhibitor minimization. Because they are very well tolerated, anti-IL-2 receptor antibodies are increasingly preferred to rabbit-antithymocyte globulin, but the former have not yet been proven to be more effective or to have less late toxicity than polyclonal agents. Benefits in early outcome and no increase in adverse events lead to recommend the use of IL-2 receptor antagonists as induction therapy after pediatric organ transplantation.
Di Filippo
Sylvie
S
Hôpital Cardiovasculaire Louis Pradel, BP Lyon Montchat, 69394, Lyon cedex 03, France. sylvie.di-filippo@chu-lyon.fr
D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000077552:Basiliximab; D065095:Calcineurin Inhibitors; D002648:Child; D000077561:Daclizumab; D006085:Graft Survival; D006801:Humans; D007108:Immune Tolerance; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007223:Infant; D016030:Kidney Transplantation / Q000276:immunology; D016031:Liver Transplantation / Q000276:immunology; D015375:Receptors, Interleukin-2 / Q000037:antagonists & inhibitors*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D065095:Calcineurin Inhibitors; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D000077561:Daclizumab