Interleukin-2 receptor antagonists in liver transplantation: a meta-analysis of randomized trials

The efficacy and safety of interleukin-2 receptor antagonist (IL-2Ra) induction therapy in liver transplantation has not reached a final conclusion. This study sought to explore the effects of IL-2Ra therapy on occurrence of biopsy-proven acute rejection (BPAR), risk of infection, and other adverse events by using meta-analysis.

We reviewed randomized trials assessing IL-2Ra therapeutic effects in liver transplantation. We synthesized published data using the random-effects and fixed-effect models, expressing results as relative risk (RR) with 95% confidence intervals (CI).

Among 12 trials including 3,251 participants, IL-2Ra significantly reduced the incidence of BPAR (RR 0.82, 95% CI 0.68-0.99) and de novo diabetes mellitus (RR 0.75, 95% CI 0.62-0.91) within 1 year. Subgroup analysis showed only daclizumab but not basiliximab treatment to significantly benefit BPAR and de novo diabetes mellitus. There were no significant differences in the graft losses (RR 1.05, 95% CI 0.85-1.31), mortality rates (RR 0.89, 95% CI 0.70-1.13), overall incidences of infection (RR 0.95, 95% CI 0.87-1.04), incidences of cytomegalovirus infections (RR 0.96, 95% CI 0.65-1.44), risks of malignancies (RR 1.06, 95% CI 0.56-2.01), or de novo hypertension (RR 0.90, 95% CI 0.79-1.03) or and renal insufficiency (RR 0.81, 95% CI 0.56-1.17, P = .26) within 1 year.

The IL-2Ra daclizumab, but not basiliximab, shows significant benefit to reduce acute rejection episodes and de novo diabetes mellitus within 1 year among patients undergoing liver transplantation. There was no evidence of an increased risk of infection or other side effects.