ADVANTAGES OF BASILIXIMAB INDUCTION COMBINED WITH MODERN IMMUNOSUPPRESSIVE DRUGS.

CLINICAL IMMUNOSUPPRESSION - KIDNEY EARLY

H. Tedesco silva, T.V.S. Freitas, C.R. Felipe, K.M. Harada, M.S. Takaoka, S.M. Kina, E.L.M. Sampaio, J.O. Medina-pestana
Kidney Transplant, Hospital do Rim e Hipertensao - UNIFESP, Sao Paulo/BRAZIL

Body: Introduction: Basiliximab induction has been increasingly used in combination with modern and efficacious immunosuppressive regimens but its effectiveness remains to be determined. Methods: We retrospectively reviewed the data of 135 deceased donor kidney transplants received basiliximab induction (from Aug2007 to MAR2009). A sequential cohort of patients who did not receive basiliximab induction (from JUN2005 to JUL2007, n=135) was used as a historical control. All patients received maintenance immunosuppressive therapy with tacrolimus (TAC), prednisone and azathioprine or mycophenolate. Results: Key findings of the analysis are show in Table 1.

Table 1	Basiliximab Group	No-induction Group	p-value
Number of Patients	135	135
Age (years)	23.6 ± 4.4	24.6 ± 4.4	0.078
Expanded criteria donor, N (%)	32 (24%)	15 (11.1%)	0.010
Cold Ischemic time in hours (hrs)	25.3 ± 6.2	23.6 ± 5.4	0.015
Incidence of acute Rejection, N (%) Expanded criteria donor Standard criteria donor	20 (14.8%) 3 (10%) 17 (16.5%)	18 (13.3%) 3 (20%) 15 (12.5%)	0.861 0.309 0.395
Development of DGF (%)	58 (42,9%)	53 (39.2%)	0.621
Mean time in DGF (days)	10.5 ± 10.0	12.6 ± 17.4	0.443
Incidence of CMV infection Expanded criteria donor Standard criteria donor	21 (15.6%) 5 (15.6%) 16 (15.5%)	28 (20.7%) 6 (40%) 22 (18.3%)	0.344 0.07 0.597
Mean serum creatinine at 6 months (mg/dl)	1.45 ±0.59	1.60 ± 0.44	0.016
TAC trough level at 6 months (ng/ml)	7.0 + 2.6	9.0 + 4.0	<0.001
Graft Survival at 12 months (%)	88.8	86.6	0.45
Patient Survival at 12 months (%)	94.5	94.6	0.92

Adding basiliximab to tacrolimus-based immunosuppressive regimens allowed the use of lower tacrolimus exposures during the first 6 months, while maintained comparable efficacy. Basiliximab induction resulted in better renal function even though a higher proportion of patients in this group received grafts from expanded criteria donors. Lower rates of acute rejection and CMV infection were observed among recipients of grafts from expanded criteria donors. Conclusion: Basiliximab induction associated to modern immunosuppressive regimens was effective, safe, allowed reduction in TAC exposure and provided superior results in recipients of organs from expanded criteria donors.

Disclosure: All authors have declared no conflicts of interest.