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Effects of interleukin 2 receptor blockers on patient and graft survival in renal-transplanted children.

Sharifian M, Arad B, Simfroosh N, Basiri A, Otukesh H, Esfandiar N - Nephrourol Mon (2014)

Bottom Line: There was lower prevalence of steroid-resistance rejection in group 1 patients (5.5%) compared with 6.6% in group 2, but it did not reach statistical significance.Induction therapy with IL2-R blockers reduced the rate of early acute rejection, but had no effect on late acute rejections.Patient and graft survival were better in treated group, but did not reach statistical significance.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Infections Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

ABSTRACT

Background: Monoclonal antibodies block interleukin-2 receptors on alloantigen-reactive T-Lymphocytes and induce selective immunosuppression. It is postulated that induction therapy with these agents in pediatric transplantation may decrease acute rejection and improve graft survival with no significant side effect or increase in the incidence of viral infections.

Objectives: The aim of this study was to examine the effects of interleukin 2 receptor blockers on patient and graft survival in renal-transplanted children.

Patients and methods: One hundred and eighty six children aged 7-13 years who received renal transplantation in university-affiliated hospital between 2003 and 2012 were enrolled in the study. All patients received prednisolone, cyclosporine and mycophenolate mofetil or azathioprine as basic immunosuppressive therapy. Patients were divided into two groups according to receiving induction therapy with IL2-receptor blockers. We investigated for acute rejection episodes, Cytomegalovirus (CMV) and BK virus infection and one and three year's survival of the patients and the grafts.

Results: From 186 renal-transplanted children included in this study, 36 patients were in treated group (group 1) and 150 patients in control group (group 2). The mean age of the patients was 10.4 ± 2 years and 55.6% were males. In first six months of transplantation, eight patients in group one had one episode of acute rejection and no one had two episodes. Early acute rejection rate was 8.36 (22%). In the control group, 37 patients had one episode and three patients had two episodes of acute rejection (rejection rate 28.6%). Therefore, early acute rejection rates were lower in group one. Late acute rejection rates did not show any difference in group 1 and group 2 (27.7% vs. 27.3% respectively). There was lower prevalence of steroid-resistance rejection in group 1 patients (5.5%) compared with 6.6% in group 2, but it did not reach statistical significance. None of the patients in IL2-R blocker group died at one year follow-up (patient survival 100%). However, in control group, four (2.6%) patients died toward the end of first year (patient survival 97.4%). When patients in group 1 and group 2 were age and sex matched with equal number the difference was significant (P < 0.05).

Conclusions: Induction therapy with IL2-R blockers reduced the rate of early acute rejection, but had no effect on late acute rejections. Patient and graft survival were better in treated group, but did not reach statistical significance. A longer period of follow-up may be required to discern a clear advantage for induction therapy with these agents.

No MeSH data available.


Related in: MedlinePlus

Primary Renal Disease of 186 Patients Underwent Renal TransplantationIL2-R blocker (n = 36) vs. no induction (n = 150) groups. P: NS. RN = Reflux Nephropathy, NB = Neurogenic Bladder, FSGS = Focal Segmental Glomerulosclerosis, PUV = Posterior Urethral Valve, BBS = Bardet-Biedl Syndrome, GN = Glomerulonephritis and PKD = Polycystic Kidney Disease. NS = Not significant.
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fig12012: Primary Renal Disease of 186 Patients Underwent Renal TransplantationIL2-R blocker (n = 36) vs. no induction (n = 150) groups. P: NS. RN = Reflux Nephropathy, NB = Neurogenic Bladder, FSGS = Focal Segmental Glomerulosclerosis, PUV = Posterior Urethral Valve, BBS = Bardet-Biedl Syndrome, GN = Glomerulonephritis and PKD = Polycystic Kidney Disease. NS = Not significant.

Mentions: Out of or of 186 children, 55.6% were male. The mean age of the patients was 10.4 ± 2 years. The youngest patient was a three-years-old boy. IL2-R blocker receiving patients included 36 patients (Group 1), while 150 patients did not receive this induction therapy (Group 2). Table 1 depicted the cause of end-stage renal failure of the two study groups. In unclassified group, three patients had obstructive uropathy, one patient had atypical Hemolitic-Uremic Syndrome (HUS), one patient had congenital nephrotic syndrome and one had primary hyperoxaluria, whom was diagnosed after transplantation. Primary renal disease of patients is shown in Figure 1 and demographic characteristics of the two study groups are shown in Table 1. Groups did not have any significant difference in demographic characteristics; however, the mean age of treated group was lower than control group.


Effects of interleukin 2 receptor blockers on patient and graft survival in renal-transplanted children.

Sharifian M, Arad B, Simfroosh N, Basiri A, Otukesh H, Esfandiar N - Nephrourol Mon (2014)

Primary Renal Disease of 186 Patients Underwent Renal TransplantationIL2-R blocker (n = 36) vs. no induction (n = 150) groups. P: NS. RN = Reflux Nephropathy, NB = Neurogenic Bladder, FSGS = Focal Segmental Glomerulosclerosis, PUV = Posterior Urethral Valve, BBS = Bardet-Biedl Syndrome, GN = Glomerulonephritis and PKD = Polycystic Kidney Disease. NS = Not significant.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4317716&req=5

fig12012: Primary Renal Disease of 186 Patients Underwent Renal TransplantationIL2-R blocker (n = 36) vs. no induction (n = 150) groups. P: NS. RN = Reflux Nephropathy, NB = Neurogenic Bladder, FSGS = Focal Segmental Glomerulosclerosis, PUV = Posterior Urethral Valve, BBS = Bardet-Biedl Syndrome, GN = Glomerulonephritis and PKD = Polycystic Kidney Disease. NS = Not significant.
Mentions: Out of or of 186 children, 55.6% were male. The mean age of the patients was 10.4 ± 2 years. The youngest patient was a three-years-old boy. IL2-R blocker receiving patients included 36 patients (Group 1), while 150 patients did not receive this induction therapy (Group 2). Table 1 depicted the cause of end-stage renal failure of the two study groups. In unclassified group, three patients had obstructive uropathy, one patient had atypical Hemolitic-Uremic Syndrome (HUS), one patient had congenital nephrotic syndrome and one had primary hyperoxaluria, whom was diagnosed after transplantation. Primary renal disease of patients is shown in Figure 1 and demographic characteristics of the two study groups are shown in Table 1. Groups did not have any significant difference in demographic characteristics; however, the mean age of treated group was lower than control group.

Bottom Line: There was lower prevalence of steroid-resistance rejection in group 1 patients (5.5%) compared with 6.6% in group 2, but it did not reach statistical significance.Induction therapy with IL2-R blockers reduced the rate of early acute rejection, but had no effect on late acute rejections.Patient and graft survival were better in treated group, but did not reach statistical significance.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Infections Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

ABSTRACT

Background: Monoclonal antibodies block interleukin-2 receptors on alloantigen-reactive T-Lymphocytes and induce selective immunosuppression. It is postulated that induction therapy with these agents in pediatric transplantation may decrease acute rejection and improve graft survival with no significant side effect or increase in the incidence of viral infections.

Objectives: The aim of this study was to examine the effects of interleukin 2 receptor blockers on patient and graft survival in renal-transplanted children.

Patients and methods: One hundred and eighty six children aged 7-13 years who received renal transplantation in university-affiliated hospital between 2003 and 2012 were enrolled in the study. All patients received prednisolone, cyclosporine and mycophenolate mofetil or azathioprine as basic immunosuppressive therapy. Patients were divided into two groups according to receiving induction therapy with IL2-receptor blockers. We investigated for acute rejection episodes, Cytomegalovirus (CMV) and BK virus infection and one and three year's survival of the patients and the grafts.

Results: From 186 renal-transplanted children included in this study, 36 patients were in treated group (group 1) and 150 patients in control group (group 2). The mean age of the patients was 10.4 ± 2 years and 55.6% were males. In first six months of transplantation, eight patients in group one had one episode of acute rejection and no one had two episodes. Early acute rejection rate was 8.36 (22%). In the control group, 37 patients had one episode and three patients had two episodes of acute rejection (rejection rate 28.6%). Therefore, early acute rejection rates were lower in group one. Late acute rejection rates did not show any difference in group 1 and group 2 (27.7% vs. 27.3% respectively). There was lower prevalence of steroid-resistance rejection in group 1 patients (5.5%) compared with 6.6% in group 2, but it did not reach statistical significance. None of the patients in IL2-R blocker group died at one year follow-up (patient survival 100%). However, in control group, four (2.6%) patients died toward the end of first year (patient survival 97.4%). When patients in group 1 and group 2 were age and sex matched with equal number the difference was significant (P < 0.05).

Conclusions: Induction therapy with IL2-R blockers reduced the rate of early acute rejection, but had no effect on late acute rejections. Patient and graft survival were better in treated group, but did not reach statistical significance. A longer period of follow-up may be required to discern a clear advantage for induction therapy with these agents.

No MeSH data available.


Related in: MedlinePlus