Use of Basiliximab as initial immunosuppression for liver transplantation is renal protective

Abstract

Aims: Post Liver Transplantation (OLT) immunosuppression involves use of CNI which is known to cause nephrotoxicity. We have developed a policy for recipients at risk of Acute Kidney Injury (AKI) peri-operatively; receiving Basiliximab as initial immunosuppression to delay use of Tacrolimus if any of the following apply: acute creatinine rise >50 μmol/L, chronic renal impairment (>120 μmol/L), intra-operative transfusion >8 units. We evaluate the outcomes of our policy within the first year post transplant. Methods: All patients who underwent OLT between March 2011 and August 2014 were included. Patients were identified for use of Basiliximab as initial immunosuppression. Results: 329 patients were included; 40% received Basiliximab. Median time for commencing Tacrolimus for those receiving Basiliximab was 7 days, 1 day for those who did not. There was no difference between age, sex, MELD, UKELD, WIT, CIT, TIT, or operative time between the groups. There was lower pre-operative eGFR in the group receiving Basiliximab (77 mL/min/1.73 m2 vs. 90 mL/min/1.73 m2 p ≤ 0.001) and use of red cell transfusion (4.3 units vs. 2 units p=<0.001). At 7 days, those who received Basiliximab still had lower eGFR (78 mL/min/1.73 m2 vs. 92 mL/min/1.73 m2 p=<0.001) and higher incidence of AKI (50% vs 9% p=<0.001). However the eGFR at 1, 3, 6, 9 and 12 months was comparable (78 mL/min/1.73 m2 vs. 80 mL/min/1.73 m2 at 12 months). However graft loss at 1 year was higher (18% vs. 7% p=0.03), as was post-operative complications (23% vs. 12% p=0.012) in those receiving Basiliximab. Conclusions: Despite lower pre-operative eGFR for those receiving Basiliximab, the long term eGFR becomes equivalent in both groups, therefore its use and may demonstrate renal protection. As there was no difference in MELD/UKELD there is no difference in incidence of hepatorenal syndrome. The higher blood transfusion use, graft loss and post-operative complications in those who received Basiliximab represent higher risk patients, with its associated risk of AKI.