In contrast, a recent registry analysis of the Organ Procurement and Transplantation Network (OPTN) showed that in renal transplant recipients maintained on tacrolimus and mycophenolate mofetil, recipients receiving basiliximab induction had significantly lower risk of triple end-points of acute rejection,

graft failure or death compared with no induction only if steroids were present at discharge (adjusted odds ratio (OR) 0.82, 95% CI 0.74, 0.92), but was not significantly different Selumetinib if steroids were absent on discharge (adjusted OR 0.69, 95% CI 0.42, 1.11).18 In our study, the lack of association between IL-2Ra induction and rejection in tacrolimus-treated recipients may be partly explained by the possibility of numbers too small to detect any differences (n = 767 compared with n = 11 164 in OPTN

analysis) and/or residual confounders. In addition, the choice to use induction therapy and/or initial CNI is often dependent on transplanting centres’ preferences, which is not collected by registry data. Our study has certain limitations. First, retrospective cohort studies are subjected to potential biases such as differing practices in the use of IL-2Ra between transplanting centres, even if these factors were accounted Cilomilast purchase for in the adjusted models. Nevertheless, there may be residual and unmeasured confounders in registry analyses that could have potentially affected our findings. Second, we had arbitrarily stratified recipients into low- and intermediate-risk recipients based on three factors – HLA-matching, PRA levels and transplant number, all of which have been shown to independently affect graft and patient

outcomes.19–21 We acknowledged that there are other factors that would define recipients’ immunological risk from including donor and recipient age, even though these are adjusted for in the multivariate models. Although this registry study does not directly provide evidence of causality, it does provide support for clinical studies of similar nature. Future trials will need to further define the role of IL-2Ra by addressing the benefit of IL-2Ra in renal transplant recipients with differing immunological risk in the era of novel and more potent immunosuppressive therapy (including cyclosporine, tacrolimus and sirolimus/everolimus-based therapy). In conclusion, the use of IL-2Ra in intermediate-risk recipients is associated with reduced rejection risk in cyclosporine-treated patients, but this does not translate to an improvement in graft or patient survival. There was no association between IL-2Ra and graft outcomes in low-risk recipients.