Interleukin-2 receptor antagonists as induction therapy after heart transplantation: systematic review with meta-analysis of randomized trials

Christian H Møller, Finn Gustafsson, Christian Gluud, Daniel A Steinbrüchel
Journal of Heart and Lung Transplantation 2008, 27 (8): 835-42

BACKGROUND: About half of the transplantation centers use induction therapy after heart transplantation. Interleukin-2 receptor antagonists (IL-2Ras) are used increasingly for induction therapy. We conducted a systematic review of randomized trials assessing IL-2Ras.

METHODS: We searched CENTRAL, PubMed, EMBASE and Web of Science up to November 2007 for randomized trials comparing IL-2Ra vs placebo/no treatment or another antibody induction therapy. Data were extracted and quality was assessed independently by two investigators. Outcome measures were mortality, biopsy-proven acute rejection (Grade > or =3A), infections and malignancy. Data were presented as the relative risk (RR) with 95% confidence interval (CI).

RESULTS: We found 9 randomized trials evaluating IL-2Ra as induction therapy after heart transplantation. All were high-bias risk trials. Four trials compared IL-2Ra with placebo/no treatment, 3 trials compared IL-2Ra with polyclonal antibody and 2 trials compared IL-2Ra with monoclonal antibody. Follow-up ranged from 6 to 12 months, except for 2 trials with up to 10 years of follow-up. When IL-2Ra vs placebo/no treatment was meta-analyzed with a fixed-effect model, IL-2Ra significantly reduced the risk of acute rejection (RR 0.73, 95% CI 0.59 to 0.90), but not according to a random-effects model (RR 0.73, 95% CI 0.46 to 1.17). IL-2Ra significantly increased acute rejection when compared with polyclonal antibody (RR 2.99, 95% CI 1.42 to 6.28), but not when compared with monoclonal antibody (RR 0.94, 95% CI 0.74 to 1.20). No significant differences were found regarding mortality, infections or malignancy.

CONCLUSIONS: Evidence for the use of induction therapy after heart transplantation is sparse. This systematic review found no convincing evidence of a survival benefit or reduction in cardiac allograft rejection. Thus, the routine use of IL-2Ra in cardiac transplantation remains unsupported.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"