Acute rejection is a known risk factor for developing chronic allograft nephropathy, which remains as a major cause of long-term graft loss. Daclizumab (Zenapax), a humanized anti interleukin-2 receptor (IL-2R) alpha monoclonal antibody, is a novel selective immunosuppressive agent for the prophylaxis of acute rejection. Six patients (aged from 32 to 48) after cadaver and living donor kidney transplantation (Tx) have been treated with Daclizumab since 2000 in Lithuania. Daclizumab was prescribed (1.0 mg/kg intravenously before Tx and once every other week afterwards (five dozes in total) for all patients, except one, who received two dozes. The induction therapy was administered due to various immunological risk factors: retransplantated, sensitized and poorly HLA-matched patients, as well as non-immunological risk factors such as patients with diabetes, with kidney from sub-optimal donors, obesity of patients, etc. The maintenance immunosuppression consisted of cyclosporine, mycophenolate mofetil and prednisolon in all patients except one, who was treated without steroids. All the patients have been folloved-up for 5-36 months. Within the observation period in early time after Tx all the patients are alive and have no clinical signs of rejection. The graft function is normal (serum creatinine ranges between 100-120 micromol/l).
Conclusion: Induction therapy with Daclizumab is safe and efficacious in preventing acute rejection in high risk kidney recipients.