Utilidad de los anticuerpos monoclonales contra el receptor de la interleucina 2 en el trasplante renal de población de riesgo

Resumo

Patients and methods. We report our experience with anti-IL-2R Abs in 32 patients (12 with basiliximab 40 mg in two doses and 20 with daclizumab 1 mg/kg in two doses) as induction therapy for renal transplantation (RT) in 18 patients with high immunologic risk (group 1: hyperimmunized, 2 or more RTs), treated also with tacrolimus (0.2 mg/kg), MMF and prednisone, and in 15 RTs from suboptimal donors (group 2: age greater than 60 years or isquemic time greater than 25 hours) using half the dose of tacrolimus. Results were compared with those of the 60 RT recipients (controls) treated with tacrolimus (0.2 mg/kg), MMF and prednisone. Results. Patients of the group 1 were younger than the remaining groups (37 ± 10 years vs 50 ± 15 in group 2 and 46 ± 12 years in control group, p < 0,05) and the age of donors was higher in group 2 (65 ± 5 vs 34 ± 15 in group 1 and 41 ± 15 years in controls, p < 0,05). In group 1, most of the patients had second transplant and they had the higher rate of preformed antibodies. Despite these differences, initial graft function rate was similar in all the groups; patients who received anti-IL-2R Abs showed less incidence of acute rejection (9% vs 27%; p < 0,05) and the graft survival at 3 years was excellent (100% in the group 1and 95% in the others groups). These benefits were obtained without observing differences in the incidence of infection, cancer or postransplantation diabetes mellitus. Conclusion. The use of anti-IL2-R Abs constitutes a great advance in induction therapy since it reduces the rate of acute rejection without increasing the incidence of side effects. In transplants using elderly donor, it allows lower doses of anticalcineurin drugs to be used with a comparable rate of early dysfunction despite the poorer graft quality.