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Interleukin-2 receptor antagonists for pediatric liver transplant recipients: A systematic review and meta-analysis of controlled studies

Interleukin-2 receptor antagonists (IL-2RA) are frequently used as induction therapy in liver transplant recipients to decrease the risk of acute rejection while allowing the reduction of concomitant immunosuppression. The exact association with the use of IL-2RA however is uncertain. We performed a systematic literature search for relevant studies. Random effects models were used to assess the incidence of acute rejection, steroid-resistant rejection, graft loss, patient death, and adverse drug reaction, with or without IL-2RA. Six studies (2 randomized and 4 nonrandomized) met the elegibility criteria. Acute rejection at 6 months or later favored the use of IL-2RA significantly (relative risk (RR) 0.38; 95% confidence interval (CI) 0.22-0.66, p = 0.0005). Although not statistically significant, IL-2RA showed a substantial reduction of the risk of steroid-resistant rejection (RR 0.32; CI 0.19-1.03, p = 0.0594). Graft loss and patient death showed a reductive tendency through the use of IL-2RA. The use of IL-2RA is safe and is associated with a statistically significantly lower incidence of acute rejection after transplantation and substantial reduction of steroid-resistant rejection, graft loss and patient death.