Basiliximab vs antithymocyte globulin after lung transplantation: A national review

Abstract

<b>Introduction:</b> Basiliximab (BAS) is an interleukin-2 monoclonal antibody used as induction therapy in kidney and liver transplantation. BAS use after lung transplantation (LTx) has grown over the years and supplanted antithymocyte globulin (ATG) as main induction immunosuppression (IIS). Few studies have compared them. <b>Objectives:</b> Compare the efficacy and safety between BAS and ATG in LTX. <b>Methods:</b> Retrospective study of all LTx done in Portugal between January 2016 and December 2019. Three groups were made according to IIS status: BAS, ATG or no induction (NI). Dosages of other immunosuppressive drugs were similar. Occurrence of rejection, cytomegalovirus (CMV) infection, side effects, early allograft dysfunction (EAD) (first 72 hours), pneumonia and death were assessed during first year after LTx. Results were compared with qui-square test. <b>Results:</b> A total of 124 patients were divided in 3 groups: 61 (49.2%) BAS; 43 (34.7%) ATG; 20 (16.1%) NI. Age and indication for LTx were similar. Side effects were reported only in ATG group [20 (46,5%)]. Incidence of pneumonia and CMV was: 65.6% BAS; 72.1% ATG; 85% NI and 18% BAS; 25.6% ATG; 5% NI; respectively. Number of rejections was 10 (16,4%) in BAS, 23 (27.9%) in ATG and 2 (10%) in NI. 70.1% of BAS group rejections and 50% of ATG occurred in first 3 months. EAD was seen in 16.4% of BAS, 11.6% ATG, and 50% NI. Number of deaths was 3 (7.0%) for BAS, 5 (8.2%) for ATG and 9 (45%) for NI groups. EAD and deaths were lower in BAS and ATG groups (p&lt;0.05). <b>Conclusion:</b> BAS had a better safety profile in LTx than ATG&nbsp;and there was no difference between rejection episodes, EAD, infection or survival. This study also reinforces the importance of IIS strategies.