Evaluation of Targeted Basiliximab Induction Therapy in Lung Transplant

Abstract

Antibody induction therapy has been shown to reduce acute rejection episodes in organ transplantation. Universal basiliximab (BAS) induction therapy was discontinued at our center due to lack of efficacy versus no induction. Targeted induction therapy with BAS was developed for patients with acute kidney injury. This study compares the incidence of acute and chronic rejection in lung transplant (txp) recipients who received basiliximab for acute kidney injury (AKI). Patients transplanted between 2008-2018 were retrospectively divided into two groups (grps): (1) BAS vs (2) no induction. Maintenance IS included a calcineurin inhibitor, mycophenolate or azathioprine, and prednisone. Acute rejection (AR) was defined as ISHLT grade A2 or greater. Variables examined included baseline characteristics, incidence of AR, infections within 12 months (mo), serum creatinine (Scr) pre- and post-txp, antibody mediated rejection, post-transplant lymphoproliferative disorder (PTLD), time to CLAD development, and patient survival. 318 patients qualified for analysis: 59 patients received BAS. The groups were comparable in regards to gender, age, diagnosis, and CMV status. Grp 2 had more single transplants (p= 0.032). Overall, AR at 12 mo was similar in both groups (15.6% vs. 19.6%, p=NS). Pre-txp Scr and Scr at 30 days post-txp were similar in both groups. Freedom from CLAD was similar in both groups at 2 years (grp 1= 36 v. grp 2= 178 pts, p= 0.163). No difference was observed between the groups regarding secondary outcomes shown in the table. However, patients receiving BAS therapy trended toward worse survival at 12 mo when compared to no induction. In conclusion, our single-center experience demonstrated similar outcomes in patients with AKI who received targeted basiliximab induction therapy in conjunction with delayed calcineurin inhibitor initiation.