Antia€“IL-2 Receptor Antibodies versus Anti-Thymocyte Globulin for Induction Therapy in Kidney Transplantation

摘要

The latest annual report from the Scientific Registry of Transplant Recipients showed that in 2006 21% of kidney recipients in the United States received no induction therapy at the time of transplantation, whereas 42% received anti-thymocyte globulin (ATG) and 29% received antia€“IL-2 receptor antibodies.1 A number of different induction agents deplete T lymphocytes, including monoclonal OKT3 and polyclonal ATG, ATGAM, and ALG. Of these four, ATG (Thymoglobulin), made from rabbits immunized with thymocytes, has been used more frequently every year since its introduction in 1998, whereas use of the others has been negligible in the past 5 yr. MAbs to the IL-2 receptor (IL-2R Abs) block T cell activation and proliferation. The two Food and Drug Administrationa€“approved IL-2R Abs, daclizumab (Zenapax) and basiliximab (Simulect), have similar efficacy and adverse effects, but basiliximab is administered as two doses within 4 d of transplantation, whereas daclizumab is administered as five infusions over 8 wk. This difference in convenience of administration likely explains the more frequent use of basiliximab.1 The IL-2R Abs were introduced in 1997, and their use increased until approximately 2001 but has declined somewhat since then with the rising popularity of ATG.1