***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIMS Immunosuppression therapy for the control of immunologic rejection is a key aspect in liver transplantation . The objective of this study was to evaluate induction therapy with daclizumab ( DAC ) in living donor liver transplantation ( LDLT ) in children . METHODS We compared 2 different immunosuppression protocol s in 30 children undergoing LDLT . The patients were divided into 2 groups : 12 patients received tacrolimus with mycophenolate mofetil ( TAC-MMF ) , and 18 patients received tacrolimus with MMF and DAC induction therapy at days 0 and 14 after LDLT ( DAC-TAC-MMF ) . Both groups were similar with regard to age , sex , weight , and indication for liver transplantation . The incidence of biopsy-proved rejection episodes , posttransplantation lymphoproliferative disease ( PTLD ) , and renal dysfunction were evaluated .  Tacrolimus levels at posttransplantation day 14 and at 2 months after transplantation were compared in the 2 groups . RESULTS Acute rejection episodes were observed in 8 patients in the TAC-MMF group ( 66 % ) , and none in the DAC-TAC-MMF group ( 0 % ; P < .05 ) . Neither PTLD nor renal dysfunction was seen in any patient . Mean Tacrolimus level on posttransplantation day 14 was 10.67 + /- 5.4 ng/mL in the TAC-MMF group and 5.65 + /- 3.6 ng/mL in the DAC-TAC-MMF group ( P < .05 ) . After the second month the mean tacrolimus levels were 7.2 + /- 2.9 ng/mL and 6.8 + /- 3.5 ng/mL in the TAC-MMF and DAC-TAC-MMF groups , respectively . ( P = NS ) . CONCLUSION Induction therapy with DAC is safe and associated with a lower incidence of rejection episodes among children undergoing LDLT It has been shown that an induction therapy with the monoclonal anti-interleukin-2 receptor antibody basiliximab ( Simulect ) is capable to reduce the incidence of acute graft rejection in adult and pediatric liver transplantation ( Ltx ) . However , data on long-term results using basiliximab in children post-Ltx are still pending . Therefore , the objective of our study was to report on the long-term results of basiliximab induction therapy in pediatric liver transplant recipients . A total of 54 children received two single doses of basiliximab in addition to cyclosporine and prednisolone following Ltx . We analyzed the incidence of acute and chronic graft rejection that of post-transplant lymphoproliferative disease ( PTLD ) , and patient and graft survival . The follow-up was 22 - 46 months . The historical control group ( matched controls ) consisted of 54 patients treated with a cyclosporine and prednisolone dual therapy .  Patient survival  was 53 of 54 in the treatment group and 51 of 54 in the controls . One patient was retransplanted in the treatment group vs. three patients in the control group . The incidence of acute graft rejection was 16.6 % compared with 53.7 % in the control group ( p < 0.001 ) , that of chronic rejection was comparable in both groups ( one of 54 vs. one of 54 ) . The incidence of steroid resistant rejection was four of 54 vs. six of 54 that of PTLD were one of 54 vs. zero of 54 . There were no adverse effects observed , which could be related to the antibody treatment . We conclude that basiliximab provides safe and effective induction immunosuppression in pediatric liver graft recipients . Short- and even long-term results are excellent Opinion statementAdvances in immunosuppressive therapy have contributed to the improved long-term survival of pediatric heart transplant recipients over the past two decades . The introduction of cyclosporine in the early 1980s ( the first oral agent to selectively target T-lymphocyte pathways ) led to a dramatic reduction in acute rejection rates and improved graft and patient survival . A combination of cyclosporine , azathioprine , and corticosteroids ( “ triple therapy ” ) became the st and ard of care for pediatric and adult heart transplantation . The introduction of several new agents in the past decade has result ed in an almost infinite number of potential immunosuppressive regimens , none of which have been ( or are likely to be ) tested in r and omized clinical trials in children .  Tacrolimus is replacing cyclosporine as the primary calcineurin inhibitor in many programs . Mycophenolate mofetil , despite its increased cost , is likely to replace azathioprine as the adjunctive antimetabolite of choice in heart transplantation . Furthermore , target of rapamycin inhibitors , such as sirolimus , will likely be used in lieu of antimetabolite agents if their known myointimal antiproliferative effects are demonstrated to reduce or prevent graft vasculopathy ( chronic rejection ) in humans . With the availability of more potent immunosuppressive agents , early steroid withdrawal or complete steroid avoidance will become the st and ard of care in most pediatric transplant programs . Complete avoidance of steroids can be facilitated by the use of induction therapy with polyclonal anti-T-cell antibodies ( eg , rabbit antithymocyte globulin [ Thymoglobulin ; SangStat Medical Corp. , Fremont , CA ] ) or with the use of nondepleting antibodies that block the interleukin-2 receptor ( eg , basiliximab , daclizumab ) . All these agents appear to have a good safety profile and are likely to lead to a resurgence of interest in induction therapy as a strategy to avoid chronic use of corticosteroids in children . As the elucidation of immunosuppressive pathways continues to advance , many newer immunosuppressive agents will be developed that target specific critical pathways in the immune response to the allograft . These advances should lead to more focused immunosuppression , greater drug synergism , reduction in the doses of individual agents , steroid-sparing regimens , and reduction in end-organ toxicities . The ultimate goal will be to define a perioperative therapeutic regimen that will result in a state of “ transplantation tolerance , ” in which the patient will indefinitely accept their allograft without the need for chronic immunosuppressive therapy BACKGROUND Currently available immunosuppressive regimens for cadaver-kidney recipients are far from ideal because acute-rejection episodes occur in about 30 % to 50 % of these patients . In the phase III study described here we assessed the ability of basiliximab , a chimeric interleukin (IL)-2 receptor monoclonal antibody , to prevent acute-rejection episodes in renal allograft recipients . METHODS 380 adult recipients of a primary cadaveric kidney transplant were r and omly allocated , in this double-blind trial , to receive a 20 mg infusion of basiliximab on day 0 ( day of surgery ) and on day 4 , to provide IL-2-receptor suppression for 4 - 6 weeks ( n=193 ) , or to receive placebo ( n=187 ) . Both groups received baseline dual immunosuppressive therapy with cyclosporin and steroids throughout the study . The primary outcome measure was incidence of acute-rejection episodes during the 6 months after transplantation . Safety and tolerability were monitored over the 12 months of the study . FINDINGS 376 patients were eligible for intention-to-treat analysis  ( basiliximab , n=190 ; placebo , n=186 ) . No significant differences in patient characteristics were apparent . The incidence of biopsy-confirmed acute rejection 6 months after transplantation was 51 ( 29.8 % ) of 171 in the basiliximab group compared with 73 ( 44.0 % ) of 166 in the placebo group ( 32 % reduction ; 14.2 % difference [ 95 % Kaplan-Meier CIs 3 % to 24 % ] , p=0.012 ) . The incidence of steroid-resistant first rejection episodes that required antibody therapy was significantly lower in the basiliximab group ( 10 % vs 23.1 % , 13.1 % difference [ 5.4 % to 20.8 % ] , p<0.001 ) . At weeks 2 and 4 post-transplantation , the mean daily dose of steroids was significantly higher in the placebo group ( p<0.001 with one-way analysis of variance ) . The incidence of graft loss at 12 months post-transplantation was 23 ( 12.1 % ) of 190 in the basiliximab group and 25 ( 13.4 % ) of 186 in the placebo group ( 1.3 % difference [ -5 % to 9 % ] , p=0.591 ) . The incidence of infection and other adverse events was similar in the two treatment groups . The acute tolerability of basiliximab was excellent , with no evidence of cytokine-release syndrome . 14 deaths  ( basiliximab n=9 ; placebo n=5 ; -2.0 % difference [ -6 % to 2 % ] , p=0.293 ) occurred during the 12-month study and a further three deaths ( basiliximab n=1 ; placebo n=2 ) occurred within the 380-day cut-off period . One post-transplantation lymphoproliferative disorder was recorded in each group . INTERPRETATION Prophylaxis with 40 mg basiliximab reduces the incidence of acute rejection episodes significantly , with no clinical ly relevant safety or tolerability concerns Avoidance of corticosteroids could be beneficial after pediatric liver transplantation ( LTx ) . To test this hypothesis , we performed a r and omized prospect i ve study to compare immunosuppression with tacrolimus ( TAC ) and steroids versus TAC and basiliximab ( BAS )  after pediatric LTx . Seventy‐two patients were recruited , 36 receiving TAC and steroids and 36 TAC and BAS .  The primary endpoint was the occurrence of the first rejection episode . Secondary endpoints were the cumulative incidence and severity of rejection , patient and graft survival , and incidence of adverse events . Overall 1‐year patient and graft survival rates were 91.4 % and 85.5 % in the steroid group , and 88.6 % and 80 % in the BAS group ( p = NS ) . Patients free from rejection were 87.7 % in the BAS group and 67.7 % in the steroid group ( p = 0.036 ) . The use of BAS was associated with a 63.6 % reduction in incidence of acute rejection episodes . Overall incidence of infection was 72.3 % in the steroid group and 50 % in the BAS group ( p = 0.035 ) . We conclude that the combination of TAC with BAS is an alternative to TAC and steroid immunosuppression in pediatric LTx , which allows for a significant reduction in the incidence of acute rejection and infectious complications Rejection remains a major threat in pediatric renal transplantation ( Tx ) , causing graft failure and increased exposure to drugs . The new chimeric antibody , basiliximab , directed against the alpha-chain of the interleukin-2 receptor ( IL-2R ) , has been shown to be effective in preventing rejection episodes in adult renal transplant recipients . In our single-center experience from Essen , Germany , we evaluated prospect ively the efficacy and tolerability of basiliximab , in combination with cyclosporin A ( CsA ) and prednisone , in 38 unselected pediatric patients . Mean patient age at Tx was 10.1 yr . Twenty-eight children received a cadaveric organ and 10 children received living-related donor grafts .  The 1-yr patient survival rate was 100 % and the 1-yr graft survival rate was 95 % ( 36/38 patients ) . No graft was lost as a result of immunological factors , and single rejection episodes were observed in eight patients ( 21 % ) . Two of these rejections were steroid-resistant and responded to tacrolimus rescue therapy . The rate of infections was not enhanced ; overt cytomegalovirus ( CMV ) disease was observed in two patients only . Malignancies have not been seen to date . The blockade of the alpha-chain of the IL-2R lasted for up to 6 weeks . We conclude that the addition of basiliximab to st and ard immunosuppression in pediatric renal transplant recipients is well tolerated and results in a low incidence of rejection . The simple mode of application and the lack of side-effects make basiliximab an especially useful adjunct in pediatric patients BACKGROUND More children are coming to heart transplantation on extracorporeal membrane oxygenation ( ECMO ) , or inotropic support and /or with renal impairment . The use of basiliximab , a chimeric monoclonal antibody against CD25 ( interleukin 2 receptor alfa ) has not been previously reported in critically ill pediatric heart transplant recipients . Basiliximab has potential advantages in the treatment of patients with renal impairment . METHODS Basiliximab was provided to 29 patients ( median age 7.8 years ; range 0.4 - 16 years ) on ECMO , with ren 
    Output:
    
Graft loss and patient death showed a reductive tendency through the use of IL-2RA .
The use of IL-2RA is safe and is associated with a statistically significantly lower incidence of AR after transplantation and substantial reduction of steroid-resistant rejection , graft loss , and patient death