Low rate of acute lung allograft rejection after the use of daclizumab, aninterleukin 2 receptor antibody

Background. The incidence and the severity of acute lung allograft rejectio n has been linked to the development of bronchiolitis obliterans syndrome. Therefore, we investigated the effects of daclizumab, a humanized monoclona l antibody directed against the alpha subunit of the interleukin 2 receptor , in reducing acute rejection after transplantation. Methods. We retrospectively evaluated 27 patients who received daclizumab a s induction immunosuppression and compared them with a historical control g roup of 34 patients. Both groups received similar immunosuppressive regimen s involving tacrolimus, prednisone, and either azathioprine or mycophenolat e mofetil, All patients received cytomegalovirus and aspergillus prophylaxi s. Results. Twenty-one patients in the control group and 22 patients in the da clizumab group were available for analysis at 6 months after lung transplan tation. Ten (48%) patients in the control group had at least grade 2 acute rejection compared with four (18%) in the daclizumab group (P <0.04). The i ncidence of infection was similar in both groups. One patient in each group developed posttransplant lymphoproliferative disease. Conclusion. Therapy with daclizumab resulted in a significant decrease in t he incidence of grade 2 or greater acute rejection after lung transplantati on compared with historical controls. There seems to be no increase in the incidence of adverse effects in the patients treated with daclizumab.