Interleukin 2 receptor antagonists for liver transplant recipients: A systematic review and meta‐analysis of controlled studies

Interleukin 2 receptor antagonists (IL‐2Ra) are frequently used as induction therapy in liver transplant recipients to decrease the risk of acute rejection while allowing the reduction of concomitant immunosuppression. We conducted a systematic review of prospective, controlled studies to test the h...

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Bibliographic Details
Published in:	Hepatology (Baltimore, Md.) Vol. 54; no. 2; pp. 541 - 554
Main Authors:	Goralczyk, Armin D., Hauke, Nicola, Bari, Narin, Y. Tsui, Tung, Lorf, Thomas, Obed, Aiman
Format:	Journal Article
Language:	English
Published:	Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-08-2011 Wiley Wiley Subscription Services, Inc
Subjects:	Acute Disease Biological and medical sciences Confidence intervals Controlled Clinical Trials as Topic Cytokines Gastroenterology. Liver. Pancreas. Abdomen Graft Rejection - prevention & control Hepatology Humans Immunosuppression - adverse effects Liver Transplantation Liver. Biliary tract. Portal circulation. Exocrine pancreas Medical sciences Receptors, Interleukin-2 - antagonists & inhibitors Transplants & implants Treatment Interleukin 2 Surgery Liver Gastroenterology Graft Transplantation Antagonist Review Homotransplantation Bibliographic review
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Summary:	Interleukin 2 receptor antagonists (IL‐2Ra) are frequently used as induction therapy in liver transplant recipients to decrease the risk of acute rejection while allowing the reduction of concomitant immunosuppression. We conducted a systematic review of prospective, controlled studies to test the hypothesis that the use of IL‐2Ra is associated with a decrease in acute rejection and/or a decrease in the side effects of concomitant medication. We performed a search of all major databases and secondary sources from inception to December 2010. Random effects models were used to assess the incidence of acute rejection, graft loss, patient death, and adverse side effects, with or without IL‐2Ra. Subgroup analysis and meta‐regression were used to explore differences in effect and sources of heterogeneity. Eighteen studies (13 randomized and 5 nonrandomized) met the inclusion and exclusion criteria. Acute rejection at 12 months or later favored the use of IL‐2Ra (relative risk [RR] 0.83; 95% confidence interval [CI] 0.76‐0.94) and steroid‐resistant rejection was also less frequent in patients receiving IL‐2Ra (RR 0.66; CI 0.48‐0.91). Graft loss and patient death did not differ significantly between treatments. Patients who received IL‐2Ra in addition to reduced or delayed calcineurin inhibitors had better renal function (mean difference of estimated glomerular filtration rate: 6.29 mL/min; CI 1.66‐10.91) and a lower incidence of renal dysfunction (RR 0.46; CI 0.27‐0.78). The use of IL‐2Ra was also associated with a lower incidence of posttransplant diabetes mellitus, whereas the incidence of other adverse events was similar. Conclusion: The use of IL‐2Ra is associated with a lower incidence of acute rejection after transplantation. Concomitant immunosuppression can be reduced, avoiding long‐term side effects of immunosuppression. (HEPATOLOGY 2011;).
Bibliography:	Potential conflict of interest: Nothing to report. fax: +49 551 3913420 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1 ObjectType-Review-4 ObjectType-Undefined-3
ISSN:	0270-9139 1527-3350
DOI:	10.1002/hep.24385