title: Risk of serious opportunistic infections after solid organ transplantation: interleukin-2 receptor antagonists versus polyclonal antibodies. A meta-analysis.
abstract: BACKGROUND
  We aimed to evaluate and quantify the risk of serious opportunistic infections after induction with polyclonal antibodies versus IL-2 receptor antagonists (IL-2RAs) in randomized clinical trials.
  
  
  METHODS
  PRISMA guidelines were followed and random-effects models were performed.
  
  
  RESULTS
  70 randomized clinical trials (10,106 patients) were selected: 36 polyclonal antibodies (n = 3377), and 34 IL-2RAs (n = 6729). Compared to controls, polyclonal antibodies showed higher risk of serious opportunistic infections (OR: 1.93, 95% CI: 1.34-2.80; p < 0.0001); IL-2RAs were associated with lower risk of serious opportunistic infections (OR: 0.80, 95% CI: 0.68-0.94; p = 0.009). Polyclonal antibodies were associated with higher risk of bacterial (OR: 1.58, 95% CI: 1.00-2.50; p = 0.049) and viral infections (OR: 2.37, 95% CI: 1.60-3.49; p < 0.0001), while IL-2RAs were associated with lower risk of cytomegalovirus (CMV) disease (OR: 0.73, 95% CI: 0.56-0.97; p = 0.032). Adjusted indirect comparison: compared to polyclonal antibodies, IL-2RAs were associated with lower risk of serious opportunistic infections (OR: 0.41, 95% CI: 0.34-0.49; p < 0.0001), bacterial infections (OR: 0.51, 95% CI: 0.39-0.67; p < 0.0001) and CMV disease (OR: 0.58, 95% CI: 0.34-0.98; p = 0.043). Results remained consistent across allografts.
  
  
  CONCLUSIONS
  The risk of serious opportunistic infections, bacterial infections and CMV disease were all significantly decreased with IL-2RAs compared to polyclonal antibodies.
authors.affiliation: Infectious Diseases Division, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
authors.forename: Marius C
authors.initials: MC
authors.lastname: Florescu
authors.forename: Wendy
authors.initials: W
authors.lastname: Grant
authors.forename: Clifford
authors.initials: C
authors.lastname: Miles
authors.forename: Michael
authors.initials: M
authors.lastname: Morris
authors.forename: R Brian
authors.initials: RB
authors.lastname: Stevens
authors.forename: Alan N
authors.initials: AN
authors.lastname: Langnas
authors.forename: Diana F
authors.initials: DF
authors.lastname: Florescu
mesh_terms: D000906:Antibodies / Q000627:therapeutic use*; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D009894:Opportunistic Infections / Q000150:complications* / Q000453:epidemiology; D016377:Organ Transplantation; D011183:Postoperative Complications / Q000382:microbiology*; D016032:Randomized Controlled Trials as Topic; D015375:Receptors, Interleukin-2 / Q000037:antagonists & inhibitors*; D018570:Risk Assessment; D014181:Transplantation Immunology
chemical_list: D000906:Antibodies; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2
keywords: IL-2 receptor antagonists; induction; infection; polyclonal antibodies