Effect of interleukin-2 receptor antibody therapy on acute rejection risk and severity, long-term renal function, infection and malignancy-related mortality in renal transplant recipients

In renal transplantation, the use of interleukin-2 receptor antibody (IL-2Ra) has been associated with reduced rejection rates, but the effect of this agent on rejection severity and type, long-term graft function and risk of infection and malignancy-related mortality remains unclear. Using Australia and New Zealand Dialysis and Transplant Registry, all live- and deceased-donor renal transplant recipients in Australia between 2000 and 2006 were included. Of the 3344 renal transplant recipients, 1874 (56.0%) received no induction and 1470 (44.0%) had received IL-2Ra. Compared with no induction, IL-2Ra was associated with reduced rejection risk (relative risk 0.70, 95% CI 0.60, 0.81) and higher estimated glomerular filtration rate at 5 years (difference in means 3.51, 95% CI 0.83, 6.19). Severity and type of rejection were similar in both the groups. The adjusted rate of death attributed to malignancy for no induction and IL-2Ra per 1000 patient-years was 1.48 and 1.63, respectively, whereas death attributed to infection was 2.42 and 2.16 respectively. This registry analysis demonstrates that IL-2Ra induction in kidney transplantation is associated with substantial clinical benefits of reduced risk of acute rejection and improved long-term graft function without an increase in adverse events.