Experience with daclizumab in liver transplantation - Renal transplant dosing without calcineurin inhibitors is insufficient to prevent acute rejection in liver transplantation

Background. Daclizumab is a monoclonal antibody directed against the cu cha in of the interleukin 2 receptor. We review our experience with the use of daclizumab in liver transplant recipients. Methods. Thirty-two patients were given daclizumab as induction therapy in the setting of hepatic transplantation. Seven of these patients were enroll ed in a pilot study to determine the efficacy of daclizumab in conjunction with corticosteroids and mycophenolate mofetil without the initial use of c alcineurin inhibitors (CI). The remaining 25 patients received daclizumab, mycophenolate mofetil, and steroids, with the institution of CI generally w ithin the first postoperative week. The majority of these patients (n=17) h ad some degree of renal insufficiency. Results, The pilot study was halted after the first seven patients were enr olled because of an unacceptably high rate of rejection (7/7=100%). The pat ients outside of this pilot study, however, had a much lower rate of reject ion (36%). The incidence and severity of rejection correlated with the dela y in institution of CI. The described dosing schedule resulted in subtherap eutic daclizumab levels in liver transplant recipients, Conclusions. Daclizumab used in liver transplant recipients without any CI was ineffective and can potentially lead to steroid-resistant rejection, Th e dosing regimen used in renal transplant recipients is most likely insuffi cient for liver transplant patients. However, daclizumab can be used safely in patients with preexisting or postoperative renal dysfunction in conjunc tion with low doses of CI given within the first week postoperatively.