Hatem Ali1,2, Karim M Soliman3, Ihab Shaheen2,4, Jon Jin Kim2,5, Mohsen El Kossi2,6, Ajay Sharma2,7, Ravi Pararajasingam2,8, Ahmed Halawa9,10. 1. Department of Renal Medicine, Royal Stoke University Hospital, NHS Foundation Trust, Stoke-on-Trent, UK. 2. Faculty of Medicine, Institute of Medical Sciences, University of Liverpool, Liverpool, UK. 3. Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. 4. Royal Hospital for Children, Glasgow, UK. 5. Nottingham Children Hospital, Nottingham, UK. 6. Renal Department, Doncaster Royal Infirmary, Doncaster, UK. 7. Transplant Surgery Department, Royal Liverpool University Hospital, Liverpool, UK. 8. Transplant Surgery Department, Sheffield Kidney Institute, Sheffield Teaching Hospitals, Sheffield, UK. 9. Faculty of Medicine, Institute of Medical Sciences, University of Liverpool, Liverpool, UK. Ahmed.halawa@liverpool.nhs.uk. 10. Transplant Surgery Department, Sheffield Kidney Institute, Sheffield Teaching Hospitals, Sheffield, UK. Ahmed.halawa@liverpool.nhs.uk.
Abstract
BACKGROUND: The aim of this meta-analysis is to explore the effect of IL-2RA vs rATG on the rate of acute rejection, post-transplant infections, and graft as well as patient's survival in standard- and high-risk renal transplant patients receiving tacrolimus-based maintenance immunotherapy. METHODS: Random effects model was the method used for identifying risk difference. Confidence interval including the value 1 was used as evidence for statistically significant risk difference. Heterogeneity was assessed using Der Simonian analysis. Heterogeneity was evident at the level of P value < 0.1 RESULTS: The random effects model showed no significant differences in both acute rejection rates between IL-2RA and rATG induction therapies with relative risk of 1.24 graft survival with relative risk 0.90. Patient survival also did not demonstrate any significant difference with a relative risk of 1.19. Random effects for CMV infection showed a lesser tendency for CMV infection in IL-2RA group compared to ATG group the with a relative risk of 0.73.In subgroup analysis, the random effects model for acute rejection rates in high-risk transplants showed a higher risk of acute rejection in the IL-2RA group compared to rATG (relative risk equals 1.55) In standard-risk transplants, there were no significant differences between both groups with relative risk equals 1.02 CONCLUSIONS: This meta-analysis revealed no significant difference in patient and graft survival when using IL-2RA vs rATG with the tacrolimus-based maintenance immunosuppression era. However, subgroup analysis showed less incidence of rejection in high-risk renal transplant recipient's population using rATG compared to IL-2RA.
BACKGROUND: The aim of this meta-analysis is to explore the effect of IL-2RA vs rATG on the rate of acute rejection, post-transplant infections, and graft as well as patient's survival in standard- and high-risk renal transplant patients receiving tacrolimus-based maintenance immunotherapy. METHODS: Random effects model was the method used for identifying risk difference. Confidence interval including the value 1 was used as evidence for statistically significant risk difference. Heterogeneity was assessed using Der Simonian analysis. Heterogeneity was evident at the level of P value < 0.1 RESULTS: The random effects model showed no significant differences in both acute rejection rates between IL-2RA and rATG induction therapies with relative risk of 1.24 graft survival with relative risk 0.90. Patient survival also did not demonstrate any significant difference with a relative risk of 1.19. Random effects for CMV infection showed a lesser tendency for CMV infection in IL-2RA group compared to ATG group the with a relative risk of 0.73.In subgroup analysis, the random effects model for acute rejection rates in high-risk transplants showed a higher risk of acute rejection in the IL-2RA group compared to rATG (relative risk equals 1.55) In standard-risk transplants, there were no significant differences between both groups with relative risk equals 1.02 CONCLUSIONS: This meta-analysis revealed no significant difference in patient and graft survival when using IL-2RA vs rATG with the tacrolimus-based maintenance immunosuppression era. However, subgroup analysis showed less incidence of rejection in high-risk renal transplant recipient's population using rATG compared to IL-2RA.
Authors: Anne P Bouvy; Mariska Klepper; Marcia M L Kho; Karin Boer; Michiel G H Betjes; Willem Weimar; Carla C Baan Journal: Nephrol Dial Transplant Date: 2014-04-24 Impact factor: 5.992
Authors: Oliver Thomusch; Michael Wiesener; Mirian Opgenoorth; Andreas Pascher; Rainer Peter Woitas; Oliver Witzke; Bernd Jaenigen; Markus Rentsch; Heiner Wolters; Thomas Rath; Tülay Cingöz; Urs Benck; Bernhard Banas; Christian Hugo Journal: Lancet Date: 2016-11-19 Impact factor: 79.321
Authors: Christian Noël; Daniel Abramowicz; Dominique Durand; Georges Mourad; Philippe Lang; Michèle Kessler; Bernard Charpentier; Guy Touchard; François Berthoux; Pierre Merville; Nacera Ouali; Jean-Paul Squifflet; François Bayle; Karl Martin Wissing; Marc Hazzan Journal: J Am Soc Nephrol Date: 2009-05-21 Impact factor: 10.121