Induction antibody therapy in renal transplantation using early steroid withdrawal: Long-term results comparing anti-IL2 receptor and anti-thymocyte globulin

• Published in: International immunopharmacology 2011-11, Vol.11 (11), p.1832-1836
• Main Authors: Libório, Alexandre B., Mendoza, Talita R., Esmeraldo, Ronaldo M., Oliveira, Maria Luiza M.B., Nogueira Paes, Fernando J.V., Silva Junior, Geraldo B., Daher, Elizabeth F.
• Format: Article
• Language: English
• Subjects: Anti-IL2 receptor; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized - administration & dosage; Antibodies, Monoclonal, Humanized - therapeutic use; Antilymphocyte Serum - administration & dosage; Antilymphocyte Serum - therapeutic use; Biological and medical sciences; Cohort Studies; Corticosteroid withdrawal; Delayed Graft Function - epidemiology; Delayed Graft Function - immunology; Delayed Graft Function - prevention & control; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Graft Rejection - epidemiology; Graft Rejection - immunology; Graft Rejection - prevention & control; Graft Survival - drug effects; Graft Survival - immunology; Humans; Immunoglobulin G - administration & dosage; Immunoglobulin G - therapeutic use; Immunosuppression; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - therapeutic use; Induction Chemotherapy - methods; Kaplan-Meier Estimate; Kidney transplant; Kidney Transplantation - immunology; Lymphocyte Depletion - methods; Male; Medical sciences; Methylprednisolone - administration & dosage; Methylprednisolone - therapeutic use; Multivariate Analysis; Pharmacology. Drug treatments; Proportional Hazards Models; Receptors, Interleukin-2 - antagonists & inhibitors; Recombinant Fusion Proteins - administration & dosage; Recombinant Fusion Proteins - therapeutic use; Retrospective Studies; Sex Factors; Thymoglobulin; Time Factors
• ISSN: 1567-5769; 1878-1705
• DOI: 10.1016/j.intimp.2011.07.012

The present study intends to investigate the effects of anti-IL2 receptors (anti-IL2R) vs. lymphocyte-depleting agents in the early steroid withdrawal (ESW) scheme. This is a retrospective cohort of 167 consecutive adult renal transplant recipients. Immunosuppression was based on tacrolimus and mycophenolate mofetil. Antibody induction therapy was carried out with lymphocyte-depleting agent (thymoglobulin) or anti-IL2R (Basiliximab or Daclizumab). ESW protocol was performed by administering intravenous methlyprednisolone as follows: 500mg on day 0, 250mg on day 1, 125mg on day 2, 60mg on day 3, and then stopped. Among the 167 studied patients, 79 (47.3%) received anti-IL2R and 88 (52.7%) received thymoglobulin induction. Significantly fewer episodes of acute rejection were seen at one year in patients treated with thymoglobulin as compared to anti-IL2R (25.6% vs. 11.4%, p=0.01). At five years, a significant difference in graft survival was observed in anti-IL2R-treated patients compared with thymoglobulin (83.5% vs. 95.5%, p=0.01). Multivariate analysis disclosed that female sex, antibody induction therapy using thymoglobulin and a trough tacrolimus level higher than 10 were protective factors against acute rejection, while there was a trend to increased risk of acute rejection at first year post-transplantation in patients presenting delayed graft function (DGF). Antibody induction was independently associated with patient and graft survival at five years (OR 0.213, 95% CI 0.046–0.991, p=0.04). ESW scheme seems to be safe and its use is beneficial since there are fewer adverse effects. Thymoglobulin induction therapy is associated with fewer rejection episodes. Induction therapy with thymoglobulin is associated with higher patient and allograft survival when comparing with anti-IL2R. ► Early steroid withdrawl is safe in renal transplantation. ► Thymoglobulin induction therapy is associated with fewer rejection episodes. ► Induction therapy with thymoglobulin is associated with higher patient and allograft survival when comparing with anti-IL2R.