Outcomes in Single versus Standard Dose Basiliximab After Lung Transplant

Abstract

<h3>Purpose</h3> Basiliximab has become the most prevalent induction agent in lung transplant (LT). There are limited studies in low-risk kidney transplant recipients, but no studies in LT. Given it's half-life of 7 days, we hypothesize there is no significant difference in rejection outcomes with single compared to double doses in the setting of lung transplantation. <h3>Methods</h3> We reviewed 93 adult patients who received single or bilateral LTs from 1/2019 - 6/2021 at our institution. Primary outcomes were development of donor-specific antibodies (DSAs) and acute cellular rejection (ACR). Pathology for ACR was collected from surveillance biopsies or when otherwise clinically indicated. Therapeutic tacrolimus was defined as greater than 8 ng/mL with goal of 1 week. All patients received dose 1 intraoperatively. Dose 2 administration on post-operative day 4 was provider driven. SPSS v26 was used for analysis. <h3>Results</h3> Characteristics were similar between the single (n=25) and the standard dose group (n=68), except more post-operative ECMO patients were in the standard dose group (p=.006, Table 1). There was no difference in grade or time to development of ACR. The single dose group achieved therapeutic tacrolimus levels sooner (p=0.009) but there was no correlation between days to therapeutic level and ACR (r=-0.042). Differences in DSA development and CMV viremia within one year were not statistically significant. <h3>Conclusion</h3> There was no difference in DSA development, ACR, or CMV viremia. Patients with PGD requiring ECMO or with post-operative renal dysfunction were given a second dose of basiliximab. Time to therapeutic tacrolimus level did not correlate with ACR, but this may be confounded by basiliximab administration in cases when tacrolimus was delayed. This suggests renal dysfunction as a possible indication for multiple dosing of basiliximab. Otherwise, a single dose could be sufficient for induction and greatly cost-effective. Further investigation is needed with increased sample size and long-term chronic rejection outcomes.