CLINICAL IMMUNOSUPPRESSION - KIDNEY EARLY

J. Harrison, B. Hamandi, O. Famure, S.J. Kim
Department Of Pharmacy Services, Toronto General Hospital, Toronto/ON/CANADA

Body: Introduction: Basiliximab is a commonly used induction agent in kidney transplantation which inhibits T lymphocyte activation and proliferation through blockade of interleukin-2 receptors. The manufacturer recommends that the first dose be given within 2 hours prior to surgery however there is limited literature examining timing of administration and effect on post-transplant outcomes. The objectives of this study were: (1) to compare renal function at one year post-transplant in patients receiving the first dose of basiliximab post-operatively vs. prior to cross-clamp removal; (2) to compare the composite of BPAR, graft loss or death at one year in the 2 groups.
Methods: All kidney transplant recipients (KTR) from 1 Jan 2002 to 31 Dec 2006 under basiliximab induction with follow-up until 31 Dec 2007 were included. Patients receiving other induction agents were excluded. Standard baseline recipient, donor and transplant characteristics were assessed. Outcomes included MDRD eGFR and Cockcroft-Gault creatinine clearance (CG-CrCl) at 1 year, delta eGFR and delta CG-CrCl at 12 vs. 1 month. The composite of BPAR, graft loss or death was also evaluated. The independent association of timing of induction with each outcome was assessed using linear and Cox regression models.
Results: The study included 167 KTR, of which 106 (63.5%) received basiliximab prior to cross-clamp removal (Pre) and 61 (36.5%) post-operatively (Post). Patients in the Post group were more likely to be older, male, recipients of a deceased donor organ, to have spent a longer time on dialysis and to have been transplanted early in the study period. The mean total basiliximab dose was 40 mg for both groups. There was no significant difference in mean MDRD eGFR (52.3 vs. 54.5 mL/min, p = 0.435) and delta eGFR (2.12 vs. 1.41, p = 0.784) for Post vs. Pre groups at one year. Similar findings were seen for mean CG-CrCl and delta CG-CrCl. The survival probabilities for the composite endpoint in the Post vs. Pre groups were 88.4% vs. 87.7% and 85.1% vs. 86.7% at 6 months and one year respectively (log-rank p = 0.259). The corresponding adjusted hazard ratio was 1.36 (95% CI, 0.66 to 2.79; p = 0.406).
Conclusion: This study suggests that timing of basiliximab administration does not have a clear role in predicting important clinical outcomes at one year including renal function or the composite of BPAR, graft loss or death. Further studies are needed to confirm these findings in a larger cohort of patients.

Disclosure: All authors have declared no conflicts of interest.