BASILIXIMAB INDUCTION IN HIGH RISK KIDNEY TRANSPLANT PATIENTS

Abstract

P1008 Objective: Evaluation of the effect of chimeric Interleuleukin-2 receptor monoclonal antibody (Basiliximab - Simulect®) as induction therapy in high risk kidney transplant (Tx) recipients (R) on the incidence and severity of acute rejection (AR) episodes, graft loss, renal function, rate and severity of infection (I) and deaths. Methods: 111 kidney Tx performed between August/1999 and May/2003 considered high risk (cadaver donor, living donor PRA>30% recipient, children, reTx, prolonged cold ischemia time and prolonged dialysis period time). The mean follow-up period was 22±11,56 months. The immunosuppressive scheme was a Calcineurin inhibitor, Mycophenolate Mofetil and Corticosteroid. Results: The mean R age was 40,65±13,67 of whom 11(9,9%) were children, 53,1% were male and 46,9% female, 52% white and 48% non-white. Cause of end stage renal dysfunction was CGN- 34%, CPN- 13%, Indeterminate- 9%, Polycystic renal disease- 4,5%, Diabetes- 4,5% and other causes- 3%. The mean time of dialytic treatment was 72,51±54,47 months (m). 57,6% of the donors were cadaver, with cold ischemia time of 21,8±5,3 hours and, from 42,4% of living donors, 27% were related with PRA>30% and 15, 4% were non-related. ReTx was performed in 14 patients (16,6%). There were 33 acute rejection episodes beginning in a mean time of 16,42%±36,46 d, only 01 (re-tx) cortico-resistant, needing monoclonal antibody therapy. The only side-effect was a seizure episode in a child. The mean creatinine level was 1,8±1,7mg/dl at the 1°m, 1,3±0,5 at the 3°m, 1,2±0,5 at the 6°m and 1,2±0,5 at the 12°m. There were 65 I episodes, with a mean time of appearance of 2,2±2,7m, mostly Urinary tract infection- 54,1%, Cytomegalovirus- 24,6%, Tuberculosis- 7,6%, Septicemia- 4,6%, Herpes virus- 4,6%, Endocarditis, Dengue and Pneumonia- 1,5%, respectively. There were 07 graft losses (04 technical, 02 due to chronic R and 01 recurrence of glomerulonephritis) in a mean time of 6,5±9,4 m. There were 04 deaths, 03 due to Sepsis at the 1°, 2° and 9°m, respectively and 01 due to anesthetic complication during lymphocele surgical correction at the 3° m. Conclusion: Considering that this group was composed by high-risk patients for AR, we concluded that Basiliximab was not only effective in AR prophylaxis, with only one cortico-resistant episode, with no immunological graft loss and a graft survival rate of 93,7% at 6° m, but was also safe, as there was no evidence of an increased risk of infective complications, besides a patient survival rate of 97,3% at the 6°m.