Interleukin 2 receptor antagonists for liver transplant recipients: a systematic review and meta-analysis of controlled studies.
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Interleukin 2 receptor antagonists for liver transplant recipients: a systematic review and meta-analysis of controlled studies. / Goralczyk, Armin D; Hauke, Nicola; Bari, Narin; Tsui, Tung Yu; Lorf, Thomas; Obed, Aiman.
in: HEPATOLOGY, Jahrgang 54, Nr. 2, 2, 2011, S. 541-554.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Interleukin 2 receptor antagonists for liver transplant recipients: a systematic review and meta-analysis of controlled studies.
AU - Goralczyk, Armin D
AU - Hauke, Nicola
AU - Bari, Narin
AU - Tsui, Tung Yu
AU - Lorf, Thomas
AU - Obed, Aiman
PY - 2011
Y1 - 2011
N2 - Interleukin 2 receptor antagonists (IL-2Ra) are frequently used as induction therapy in liver transplant recipients to decrease the risk of acute rejection while allowing the reduction of concomitant immunosuppression. We conducted a systematic review of prospective, controlled studies to test the hypothesis that the use of IL-2Ra is associated with a decrease in acute rejection and/or a decrease in the side effects of concomitant medication. We performed a search of all major databases and secondary sources from inception to December 2010. Random effects models were used to assess the incidence of acute rejection, graft loss, patient death, and adverse side effects, with or without IL-2Ra. Subgroup analysis and meta-regression were used to explore differences in effect and sources of heterogeneity. Eighteen studies (13 randomized and 5 nonrandomized) met the inclusion and exclusion criteria. Acute rejection at 12 months or later favored the use of IL-2Ra (relative risk [RR] 0.83; 95% confidence interval [CI] 0.76-0.94) and steroid-resistant rejection was also less frequent in patients receiving IL-2Ra (RR 0.66; CI 0.48-0.91). Graft loss and patient death did not differ significantly between treatments. Patients who received IL-2Ra in addition to reduced or delayed calcineurin inhibitors had better renal function (mean difference of estimated glomerular filtration rate: 6.29 mL/min; CI 1.66-10.91) and a lower incidence of renal dysfunction (RR 0.46; CI 0.27-0.78). The use of IL-2Ra was also associated with a lower incidence of posttransplant diabetes mellitus, whereas the incidence of other adverse events was similar. CONCLUSION: The use of IL-2Ra is associated with a lower incidence of acute rejection after transplantation. Concomitant immunosuppression can be reduced, avoiding long-term side effects of immunosuppression.
AB - Interleukin 2 receptor antagonists (IL-2Ra) are frequently used as induction therapy in liver transplant recipients to decrease the risk of acute rejection while allowing the reduction of concomitant immunosuppression. We conducted a systematic review of prospective, controlled studies to test the hypothesis that the use of IL-2Ra is associated with a decrease in acute rejection and/or a decrease in the side effects of concomitant medication. We performed a search of all major databases and secondary sources from inception to December 2010. Random effects models were used to assess the incidence of acute rejection, graft loss, patient death, and adverse side effects, with or without IL-2Ra. Subgroup analysis and meta-regression were used to explore differences in effect and sources of heterogeneity. Eighteen studies (13 randomized and 5 nonrandomized) met the inclusion and exclusion criteria. Acute rejection at 12 months or later favored the use of IL-2Ra (relative risk [RR] 0.83; 95% confidence interval [CI] 0.76-0.94) and steroid-resistant rejection was also less frequent in patients receiving IL-2Ra (RR 0.66; CI 0.48-0.91). Graft loss and patient death did not differ significantly between treatments. Patients who received IL-2Ra in addition to reduced or delayed calcineurin inhibitors had better renal function (mean difference of estimated glomerular filtration rate: 6.29 mL/min; CI 1.66-10.91) and a lower incidence of renal dysfunction (RR 0.46; CI 0.27-0.78). The use of IL-2Ra was also associated with a lower incidence of posttransplant diabetes mellitus, whereas the incidence of other adverse events was similar. CONCLUSION: The use of IL-2Ra is associated with a lower incidence of acute rejection after transplantation. Concomitant immunosuppression can be reduced, avoiding long-term side effects of immunosuppression.
KW - Humans
KW - Acute Disease
KW - Controlled Clinical Trials as Topic
KW - Liver Transplantation
KW - Graft Rejection/prevention & control
KW - Immunosuppression/adverse effects
KW - Receptors, Interleukin-2/antagonists & inhibitors
KW - Humans
KW - Acute Disease
KW - Controlled Clinical Trials as Topic
KW - Liver Transplantation
KW - Graft Rejection/prevention & control
KW - Immunosuppression/adverse effects
KW - Receptors, Interleukin-2/antagonists & inhibitors
M3 - SCORING: Journal article
VL - 54
SP - 541
EP - 554
JO - HEPATOLOGY
JF - HEPATOLOGY
SN - 0270-9139
IS - 2
M1 - 2
ER -