Initial Immunosuppression With or Without Basiliximab: A Comparative Study

• Published in: Transplantation proceedings Vol. 44; no. 9; pp. 2570 - 2572
• Main Authors: Martín-Mateos, R.M, Graus, J, Albillos, A, Arocena, C, Rodríguez Gandía, M.A, Blesa, C, García-Hoz, F, García González, M, García-Alonso, F.J, Bárcena, R
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01-11-2012; Elsevier
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - prevention & control; Adrenal Cortex Hormones - therapeutic use; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Biological and medical sciences; Calcineurin Inhibitors; Chi-Square Distribution; Communicable Diseases - epidemiology; Drug Therapy, Combination; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - epidemiology; Graft Rejection - immunology; Graft Rejection - prevention & control; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Incidence; Intensive Care Units; Length of Stay; Liver Transplantation - adverse effects; Liver Transplantation - immunology; Logistic Models; Male; Medical sciences; Middle Aged; Multivariate Analysis; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Recombinant Fusion Proteins - adverse effects; Recombinant Fusion Proteins - therapeutic use; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tacrolimus - therapeutic use; Time Factors; Tissue, organ and graft immunology; Treatment Outcome; Immunomodulator; Medicine; Immunosuppression; Treatment; Surgery; Basiliximab; Immunotherapy; Graft; Transplantation; Monoclonal antibody; Immunosuppressive agent; Comparative study
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2012.09.109

Abstract Background Following liver transplantation, acute kidney injury (AKI) and chronic kidney disease occur in 20%–50% and 30%–90% of patients, respectively. Basiliximab, a chimeric monoclonal antibody, is highly effective to prevent rejection in organ transplant recipients, particularly among patients with renal dysfunction who benefit from delayed introduction of calcineurin inhibitors. Objective The objective of this study was to measure the immunosuppressive effect of basiliximab and its impact on renal failure, lengths of hospital and intensive care unit (ICU) stays and prevalence of infection. Methods From January 2010 through December 2011, we performed a controlled, nonrandomized study comparing two different immunosuppressive regimens: Group I, 36 transplantation on 34 patients, tacrolimus and corticosteroids de novo with mycophenolate mofetil in cases of renal failure; and Group II, 33 transplantation in 33 patients, corticosteriods and mycophenolate mofetil de novo with basiliximab on day 0 and day 4, and inception of tacrolimus on day 3. Results Basiliximab patients (Group II) showed a significantly lower incidence of renal failure requiring replacement therapy (3.03% vs 25%; P = .014). The incidence of acute cellular rejection episodes treated with corticosteriod boluses was also significantly lower (3.03% vs 25%; P = .014). Bacterial, fungal, and cytomegalovirus infection rates were lower in Group II, although the differences were not significant. Similarly, Group II patients had an insignificantly shorter average stay in the hospital (25.9 vs 40.06 days) and the ICU (5.9 vs 8.17 days). Conclusions Basiliximab administration with delayed introduction of calcineurin inhibitors may be an effective strategy to reduce post-liver transplantation AKI requiring renal replacement therapy.