INDUCTION IMMUNOSUPPRESSION

A. Webster¹, L.P. Ruster¹, R. Mc gee², S.L. Matheson¹, G.Y. Higgins², N.S. Willis², J.R. Chapman², J. Craig^2
1School Of Public Health, University of Sydney, Sydney/NSW/AUSTRALIA, ²Westmead Children's Hospital, Centre for Kidney Research, Sydney/AUSTRALIA

Body: Introduction: To summarise the effects of IL2Ra as an alternative to ATG induction. This is an update of a previous systematic review published in 2004. Methods: The literature was searched systematically for all relevant randomised trials. Summary estimates were calculated using random effects relative risk (RR) with 95% confidence intervals (CI), where values <1 favour IL2Ra. Where appropriate, we used metaregression and calculated numbers needed to treat (NNT). Results: Eighteen studies (1,844 participants) compared IL2Ra to an ATG preparation (12 studies of 1,387 participants used rabbit and 6 of 457 participants used equine ATG). 7 trials had low-risk participants for acute rejection, 5 had mixed-risk participants, 5 had high risk participants and 1 had unclear risk. There was no difference in mortality, graft loss, or clinically diagnosed acute rejection. ATG therapy was better than IL2Ra for preventing biopsy-proven acute rejection at one year (RR 1.30, 95% CI: 1.01, 1.67) but at the cost of more malignancy (RR 0.25, 95% CI: 0.07, 0.87) and more CMV disease (RR 0.72, 95% CI: 0.48, 1.07) (See Table 1). There was no evidence that the effects of IL2Ra were different depending on the study population baseline risk of acute rejection (low/mixed versus high risk, P=0.12) or formulation of ATG comparator (risk of rejection: rabbit versus horse, P=0.96). See Figure 1. Conclusions: ATG may reduce the risk of some experiencing acute rejection but increase the risk of malignancy by 75% (NNT 58), CMV disease by 28% (NNT 16) and with no difference in graft loss or mortality.

Disclosure: All authors have declared no conflicts of interest.