title: Interleukin-2 receptor antibody does not reduce rejection risk in low immunological risk or tacrolimus-treated intermediate immunological risk renal transplant recipients.
abstract: OBJECTIVE
  The use of interleukin-2 receptor antibody (IL-2Ra) induction has been associated with reduced rejection rates in renal transplant recipients. However, the effect of IL-2Ra induction on graft and patient outcomes in renal transplant recipients with differing immunological risk remains unclear.
  
  
  METHODS
  Using Australia and New Zealand Dialysis and Transplant Registry, renal transplant recipients in Australia between 1995 and 2005 were included. Recipients were stratified into low immunological risk (primary grafts with < or = 2 human leucocyte antigen (HLA)-mismatches and panel-reactive antibody (PRA) < 10%) or intermediate immunological risk (subsequent grafts or >2 HLA-mismatches or PRA > 25%) recipients. Recipients receiving T-cell depletive induction therapy or steroid and/or calcineurin-free inhibitor regimens were excluded. Outcomes analysed included the presence of rejection at 6 months, estimated glomerular filtration rate at 1 and 5 years, graft and patient survival.
  
  
  RESULTS
  218 of 1220 (18%) low-risk and 883 of 3204 (28%) intermediate-risk recipients received IL-2Ra. In intermediate-risk recipients, IL-2Ra induction was associated with a 26% reduction in the incidence of acute rejection; but this benefit was restricted only to recipients initiated on cyclosporine-based immunosuppressive regimens. In contrast, the use of IL-2Ra in low-risk recipients was not associated with reduced rejection risk. There was no association between IL-2Ra induction and other graft or patient outcomes in both low- and intermediate-risk recipients.
  
  
  CONCLUSIONS
  This registry analysis suggests that IL-2Ra induction may be associated with a reduction in rejection risk in cyclosporine-treated intermediate immunological risk recipients, but not in low-risk renal transplant recipients.
authors.affiliation: Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia. wai.lim@health.wa.gov.au
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Chadban
authors.forename: Scott
authors.initials: S
authors.lastname: Campbell
authors.forename: Hannah
authors.initials: H
authors.lastname: Dent
authors.forename: Graeme R
authors.initials: GR
authors.lastname: Russ
authors.forename: Stephen P
authors.initials: SP
authors.lastname: McDonald
mesh_terms: D000328:Adult; D000906:Antibodies / Q000627:therapeutic use*; D001315:Australia; D016009:Chi-Square Distribution; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D015375:Receptors, Interleukin-2 / Q000276:immunology*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016559:Tacrolimus / Q000009:adverse effects*; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2; D016559:Tacrolimus