Interleukin-2–Receptor Blockade with Daclizumab to Prevent Acute Rejection in Renal Transplantation

TLDR

Monoclonal antibodies targeting the high‑affinity IL‑2 receptor on alloantigen‑reactive T cells can provide selective immunosuppression. In a randomized trial, 260 first‑time kidney transplant recipients received daclizumab (1 mg/kg) or placebo, with five intravenous doses given pre‑transplant and biweekly thereafter, and were followed for 12 months. Daclizumab lowered biopsy‑confirmed acute rejection at six months from 35 % to 22 % (P = 0.03) and improved 12‑month graft survival (95 % vs 90 %), with no increase in adverse events, demonstrating a reduction in rejection frequency.

Abstract

Monoclonal antibodies that block the high-affinity interleukin-2 receptor expressed on alloantigen-reactive T lymphocytes may cause selective immunosuppression. Daclizumab is a genetically engineered human IgG1 monoclonal antibody that binds specifically to the alpha chain of the interleukin-2 receptor and may thus reduce the risk of rejection after renal transplantation.We administered daclizumab (1.0 mg per kilogram of body weight) or placebo intravenously before transplantation and once every other week afterward, for a total of five doses, to 260 patients receiving first cadaveric kidney grafts and immunosuppressive therapy with cyclosporine, azathioprine, and prednisone. The patients were followed at regular intervals for 12 months. The primary end point was the incidence of biopsy-confirmed acute rejection within six months after transplantation.Of the 126 patients given daclizumab, 28 (22 percent) had biopsy-confirmed episodes of acute rejection, as compared with 47 of the 134 patients (35 percent) who received placebo (P=0.03). Graft survival at 12 months was 95 percent in the daclizumab-treated patients, as compared with 90 percent in the patients given placebo (P=0.08). The patients given daclizumab did not have any adverse reactions to the drug, and at six months, there were no significant differences between the two groups with respect to infectious complications or cancers. The serum half-life of daclizumab was 20 days, and its administration resulted in prolonged saturation of interleukin-2alpha receptors on circulating lymphocytes.Daclizumab reduces the frequency of acute rejection in kidney-transplant recipients.