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Use of IL‐2 receptor antagonists to reduce delayed graft function following renal transplantation: a review
Author(s) -
Sandrini Silvio
Publication year - 2005
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2005.00417.x
Subject(s) - medicine , calcineurin , urology , nephrotoxicity , transplantation , incidence (geometry) , kidney transplantation , renal function , kidney , physics , optics
Delayed graft function (DGF) occurs in approximately 30% of renal transplant patients, and significantly increases risk of long‐term graft loss. This article reviews the potential for use of interleukin‐2 receptor (IL‐2R) antagonists to reduce the burden of DGF. IL‐2R antagonists decrease incidence of acute rejection without increasing risk of cytomegalovirus infection or malignancy, and show equivalent efficacy to lymphocyte‐depleting antibody agents in standard risk patients with immediate graft function. The nephrotoxicity associated with calcineurin inhibitors (CNIs) has led to use of delayed or low‐dose CNI regimens with induction therapy in patients with DGF. In this setting, use of an IL‐2R antagonist with mycophenolate mofetil and steroids with delayed cyclosporine appears to be associated with a low incidence of biopsy‐proven rejection and comparable renal function to patients with immediate function. Additionally, there is intriguing evidence to suggests that IL‐2R antagonists may reduce risk of DGF occurring. A number of large‐scale and smaller studies have reported a trend to reduced incidence of DGF or improved early renal function using IL‐2R antagonists compared with placebo, although data are not entirely consistent. In conclusion, the ability of IL‐2R antagonists to reduce acute rejection with no additional safety concerns makes them an attractive option for patients with DGF.