Transplant Trial Watch

Outcomes of Interleukin-2 Receptor Antagonist Induction Therapy in Standard-Risk Renal Transplant Recipients Maintained on Tacrolimus: A Systematic Review and Meta-Analysis.

Ali, H., et al.

American Journal of Nephrology 2021; 52(4): 279-291.


Aims
This study aimed to assess the outcomes of prospective and randomised case-control studies investigating interleukin-2 receptor antagonist (IL2-RA) induction therapy in standard-risk renal transplant recipients maintained on tacrolimus.

Interventions
Electronic databases including Medline, PubMed, Cochrane and Embase were searched. Study selection was performed by two independent reviewers. The Newcastle-Ottawa score was used to assess the risk of bias.

Participants
13 studies were included in the review.

Outcomes
Patient survival, graft survival, delayed graft function, acute rejection rates, malignancy and cytomegalovirus (CMV) infection.

Follow-up
N/A

CET Conclusions
The meta-analysis evaluated outcomes of interleuking-2 receptor antagonist (IL2-RA) induction therapy in standard-risk kidney transplant recipients on tacrolimus. The bibliographic search identified 13 comparative studies by independent reviewers, including five randomised controlled trials (RCTs), of IL2-RA induction therapy versus no-induction therapy. Standard-risk was defined as PRA<50% or total HLA mismatch<5. The methodological quality of cohort studies was assessed using the Newcastle Ottawa scale showing high quality scores for all studies. However, the authors also used the tool to assess the quality of RCTs, which is really not appropriate for this study design. It was unclear whether data extraction and quality assessment was conducted by independent reviewers. Meta-analyses of studies did not show differences between groups for any of the outcomes, including patient and survival, acute rejection, delayed graft function, kidney function, malignancies and infections. A second analysis compared studies IL2-RA and low-dose tacrolimus versus no-induction and high dose of tacrolimus and also did not find any differences. Heterogeneity in all meta-analyses was low.

Trial registration
PROSPERO - CRD42020187728

Funding source
No funding received