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Abstract: FR-PO1182

Induction Therapies in the Tacrolimus-Based Immunosuppression Era: A Meta-Analysis

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Soliman, Karim Magdy Mohamed, Medical University of South Carolina , Charleston, South Carolina, United States
  • Ali, Hatem, Heartlands hospital, Birmingham, United Kingdom
  • Daoud, Ahmed, Cairo University, Cairo, Egypt
  • Fulop, Tibor, Medical University of South Carolina, Charleston, South Carolina, United States
  • Halawa, Ahmed, Liverpool university, Liverpool, United Kingdom
Background

Induction therapy with rabbit Anti-thymocyte Globulin (rATG) and IL-2 Receptor Antagonist (IL-2RA) resulted in marked reduction of acute allograft rejection rate. However, the relative value of these agents in the era tacrolimus-based maintenance immunosuppression remains uncertain.

Methods

A systematic review of Pubmed, Medline, Embase and Cochrane databases was conducted to identify outcomes in terms of graft and patient survival, rejection, infection and malignancy rates in renal transplant recipients (RTRs) (Figure 1). Based on received induction therapy, RTRs were divided into 2 groups (IL2-RA versus rATG). All subjects were on tacrolimus-based immunosuppression. The meta-analysis included 6 randomized case-control studies with total of 1017 subjects and follow-up period ranged from 12 months to 36 months. Random effects model (REM) was used to identify risk difference. Confidence interval excluding the value 1 was used as evidence for statistically significant risk difference. Heterogeneity was assessed using Der Simonian analysis (P value<0.1).

Results

The REM showed no significant differences in acute rejection rates, graft survival and patient survival between IL2-A and rATG induction therapies with confidence interval ranges (CIR) from 0.94 to 1.64, 0.57 to 1.42 [relative risk (RR): 0.9], and 0.6 to 2.35, RR:1.19 respectively (Figure 2, 3). REM for CMV infection showed a lesser tendency for CMV infection and higher rate of acute rejection in high-risk transplants of the IL2-RA group compared to ATG group with CIR from 0.52 to 1.05 (RR: 0.73) and 1.05 to 2.51 (RR: 1.55) respectively. In standard risk transplants, there were no significant differences between acute rejection rates (CIR from 0.71 and 1.47, RR: 1.02).

Conclusion

This meta-analysis revealed no significant difference in patient and graft survival when using IL-2RA vs rATG with the tacrolimus-based maintenance immunosuppression. Subgroup analysis noted a trend for reduced rejection in high-risk recipients receiving rATG compared to IL-2RA.