Use of daclizumab as initial immunosuppression in liver transplant recipients with impaired renal function

The addition of daclizumab (a human immunoglobulin G1 monoclonal antibody t hat blocks interleukin-2 receptors on T lymphocytes) to mycophenolate mofet il (MMF) and steroids is a new option for initial immunosuppression in pati ents undergoing liver transplantation (LT) with impaired renal function. We evaluated the efficacy and safety of daclizumab in preventing rejection in 25 patients with impaired kidney function undergoing LT. Patients with ser um creatinine (Cr) levels greater than 2 mg/dL immediately before LT were a dministered initial immunosuppression with daclizumab, 1 mg/kg, in addition to MMF, 2 g/d, and methylprednisolone. Tacrolimus mas added after kidney f unction improved (when Cr levels improved by >25% of initial value). Dacliz umab-treated patients mere compared retrospectively with 2 other groups of patients who underwent LT with kidney impairment (Cr > 2 mg/dL): 56 patient s were administered OKT3 induction, and 48 patients were administered low-d ose tacrolimus. The incidence of rejection and infection (bacterial, fungal , and viral), need for preoperative and postoperative dialysis, Cr level im mediately post-LT and at 3 months, and graft and patient survival were anal yzed. There was no difference among the groups in 3-month Cr levels or the incidence of rejection or fungal or viral infection. The daclizumab group h ad fewer bacterial infections (n = 13) than the tacrolimus group (n = 28) a nd significantly fewer than the OKT3 group (n = 58; P =.006). Only 1 patien t (4%) in the daclizumab group required dialysis post-LT versus 13 patients in each of the other groups (OKT3, 23.21%; P <.05; tacrolimus, 27%). In th e daclizumab group, 2-year patient and graft survival rates were statistica lly significant compared with the low-dose tacrolimus group (89% and 81% v 73% and 69%, respectively; P =.06). There were no side effects related to d aclizumab use, and all patients tolerated the drug well. In patients with i mpaired renal function before LT, daclizumab-based initial immunosuppressio n can be used safely to reduce the risk for infection and need for dialysis post-LT, with improved longterm graft and patient survival.