Increased risk of rejection after basiliximab induction in sensitized kidney transplant recipients without pre-existing donor-specific antibodies - a retrospective study

Transpl Int. 2019 Aug;32(8):820-830. doi: 10.1111/tri.13428. Epub 2019 Apr 12.

Abstract

Depleting induction therapy is recommended in sensitized kidney transplant recipients (KTRs), though the detrimental effect of nondonor-specific anti-HLA antibodies is not undeniable. We compared the efficacy and safety of basiliximab and rabbit anti-thymocyte globulin (rATG) in sensitized KTRs without pre-existing donor-specific antibodies (DSAs). This monocentric retrospective study involved all sensitized KTR adults without pre-existing DSAs (n = 218) who underwent transplantation after June 2007. Patients with basiliximab and rATG therapy were compared for risk of biopsy-proven acute rejection (BPAR) and a composite endpoint (BPAR, graft loss and death) by univariate and multivariate analysis. Patients with basiliximab (n = 60) had lower mean calculated panel reactive antibody than those with rATG (n = 158; 23.7 ± 24.2 vs. 63.8 ± 32.3, P < 0.0001) and more often received a first graft (88% vs. 54%, P < 0.0001) and a transplant from a living donor (13% vs. 2%, P = 0.002). Risks of BPAR and of reaching the composite endpoint were greater with basiliximab than rATG [HR = 3.63 (1.70-7.77), P = 0.0009 and HR = 1.60 (0.99-2.59), P = 0.050, respectively]. Several adjustments did not change those risks [BPAR: 3.36 (1.23-9.16), P = 0.018; composite endpoint: 1.83 (0.99-3.39), P = 0.053]. Infections and malignancies were similar in both groups. rATG remains the first-line treatment in sensitized KTR, even in the absence of pre-existing DSAs.

Keywords: basiliximab; induction; kidney transplantation; rabbit anti-thymocyte globulin; rejection.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Animals
  • Antibodies / immunology*
  • Antilymphocyte Serum / therapeutic use*
  • Basiliximab / therapeutic use*
  • Biopsy
  • Female
  • Graft Rejection*
  • Graft Survival
  • Humans
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / mortality
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Rabbits
  • Retrospective Studies
  • Risk
  • Tissue Donors
  • Transplantation Conditioning / methods
  • Treatment Outcome

Substances

  • Antibodies
  • Antilymphocyte Serum
  • Basiliximab