Single-Dose Basiliximab Induction in Low-Risk Renal Transplant Recipients

• Published in: Pharmacotherapy Vol. 36; no. 7; p. 823
• Main Authors: Cunningham, Kathleen C, Hager, David R, Fischer, Jessica, D'Alessandro, Anthony M, Leverson, Glen E, Kaufman, Dixon B, Djamali, Arjang
• Format: Journal Article
• Language: English
• Published: United States 01.07.2016
• Subjects: Adult; Aged; Antibodies, Monoclonal - therapeutic use; Delayed Graft Function - etiology; Female; Graft Survival; Humans; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - adverse effects; Kidney Transplantation - mortality; Male; Middle Aged; Proportional Hazards Models; Recombinant Fusion Proteins - therapeutic use; basiliximab; induction; patient death; graft loss; rejection; kidney transplantation
• ISSN: 1875-9114
• DOI: 10.1002/phar.1774

To compare the efficacy of a single dose of basiliximab with two doses in preventing acute rejection in selected low-risk renal transplant recipients. This observational study of 760 kidney transplant recipients considered to be at low immunologic risk (peak panel reactive antibody less than 10%) compared patient and graft outcomes following a single-dose versus a two-dose regimen of basiliximab. No differences were found in patient survival (92% vs 92%, p=0.6), graft survival (86% vs 83%, p=0.2), acute rejection (cellular [4% vs 7%, p=0.2], antibody-mediated rejection [19% vs 19%, p=0.9]), or opportunistic infections (34% vs 30%, p=0.3) between the single versus two-dose regimens, respectively. In multivariate analyses, the number of doses of basiliximab was not associated with acute rejection or patient/graft survival despite adjustment with Cox regression and propensity scores. However, delayed graft function (DGF), donor age older than 65 years, and human leukocyte antigen mismatch of 3 or higher were associated with acute rejection (hazard ratio [HR] 2.64, 1.91, and 1.57, respectively, p≤0.04), and DGF and diabetes were associated with death/graft loss (HR 2.56 and 1.63, respectively, p≤0.009). A single dose of basiliximab is safe and effective for induction in low-risk kidney transplant recipients.