Daclizumab induction therapy in liver transplant recipients with renal insufficiency


Dr W. R. Kim, 200 First Street SW, Rochester, MN 55905, USA.
E-mail: kim.ray@mayo.edu


Background  The role of interleukin 2 (IL-2) receptor antibodies to avoid the nephrotoxic effects of calcineurin inhibitors in the early post-liver transplant (LT) period is not well defined.

Aim  To examine the use of daclizumab induction in LT recipients with renal insufficiency.

Methods  Between 2002 and 2005, 62 patients (median pre-LT creatinine 2.4 mg/dL, IQR 1.9–3.7) received daclizumab induction with tacrolimus being administered when serum creatinine was <2.0 mg/dL. A concurrent comparison group (n = 221, 2002–2005) received tacrolimus-based immunosuppression without daclizumab (median pre-LT creatinine 1.1 mg/dL, IQR 0.9–1.4). A second historical comparison group (n = 103, 1995–2005) not receiving daclizumab was matched to the daclizumab patients by pre-LT serum creatinine (2.2 mg/dL, IQR 1.8–3.1). All patients received mycophenolate mofetil and steroids.

Results  Serum creatinine improved in the daclizumab group (−1.0 mg/dL, IQR −2.2 to −0.4) and worsened in the concurrent comparison group (+0.2 mg/dL, IQR 0–0.5) from pre-LT to 4 months. However, there was no difference when daclizumab group was compared with the historical comparison group matched on pre-LT creatinine (median change: −0.8 mg/dL vs. −0.7 mg/dL). Daclizumab induction was not associated with improvement in renal function at 4 months (P = 0.34) after adjusting for pre-LT creatinine, age, gender, hepatitis C status and simultaneous liver kidney transplantation.

Conclusion  The incremental benefit offered by induction therapy with IL-2 receptor antibodies to preserve renal function is questionable.