The CARI guidelines. Calcineurin inhibitors in renal transplantation: the addition of anti-CD25 antibody induction to standard immunosuppressive therapy for kidney transplant recipients.

Interleukin 2 (IL2)-mediated activation of lymphocytes is a critical pathway in the cellular immune response of acute kidney transplant rejection. Anti-CD25 antibodies (antiCD25ab, also known as IL2 receptor antagonists (IL2RA)) are humanized or chimeric IgG monoclonal antibodies to the alpha subunit of the CD25 receptor present only on activated T lymphocytes and competitively antagonize this IL2-mediated activation. The rationale for using anti-CD25ab has been as induction agents in the peri-transplant period, used together with standard agents to try to minimize early graft injury by preventing acute rejection or to minimize exposure to the calcineurin inhibitors (particularly in recipients deemed at high risk of delayed initial graft function), thereby ameliorating the shortand long-term nephrotoxic side-effects of both cyclosporin and tacrolimus. Anti-CD25ab are commercially available as basiliximab and daclizumab. The use of anti-CD25ab has increased globally since their introduction in the mid-1990s, with 38% of new kidney transplant recipients in the United States, and 23% in Australasia receiving IL2RA in 2002. In Australia and New Zealand, the widespread use of anti-CD25ab is limited by local funding arrangements and variability in clinical practice. SEARCH STRATEGY