Basiliximab Versus Daclizumab Combined With Triple Immunosuppression in Deceased Donor Renal Transplantation: A Prospective, Randomized Study

Abstract

Basiliximab or daclizumab combined with triple therapy was an efficient and a safe immunosuppression strategy, demonstrated with low incidence of acute rejections, excellent graft function, high survival rates, and acceptable adverse event profile in adult recipients within the 1st year after deceased donor renal transplantation.

Randomized Trial of Three Induction Antibodies in Kidney Transplantation

“…In terms of randomized trials comparing ATG versus daclizumab or basiliximab, two studies reported no differences in clinical outcomes at 6 and 12 months posttransplant between use of ATG versus basiliximab (52,53), and one randomized study of daclizumab versus basiliximab reported no differences in clinical outcomes at 12 months posttransplant (54). Conversely, one randomized trial of higher-risk patients reported a significantly lower BPAR rate at 12 months and less need for antibody treatment of BPAR in patients who received ATG versus basiliximab; however, graft survival was similar in the two treatment arms at 12 months posttransplant (55).…”

Randomized Trial of Dual Antibody Induction Therapy With Steroid Avoidance in Renal Transplantation

“…Although bioavailability of TAC is known to be markedly lower among African Americans (i.e., a higher TAC dose is required to achieve a specified 12-hour trough level) (43,44), the observed trend for lower bioavailability of TAC in the ATG/C1H arm will require further observation, as factors such as race/ ethnicity, use of alemtuzumab, or a lower EC-MPS dose in the ATG/C1H arm may have contributed to this surprising finding, although it may have occurred by chance alone. Furthermore, although Dac is no longer available, successful combination of ATG/basiliximab as dual induction in kidney transplantation has been reported (21,22) along with equivalency in clinical outcomes using basiliximab versus Dac (10). Finally, although determination of a best single-agent induction strategy in renal transplantation is still of great interest as demonstrated by two recent randomized trials comparing ATG and basiliximab versus alemtuzumab (45,46), the focus of the current study was to compare two distinct dual-induction strategies using less aggressive dosing for each agent than if used alone at our center.…”

“…A recent therapeutic strategy after renal transplantation includes simultaneous use of reduced calcineurin inhibitor dosing, maximized use of a non-nephrotoxic, antiproliferative drug (inosine monophosphate dehydrogenase [IMPDH] or TOR inhibitor), and single-agent, antibody induction (lymphodepleting polyclonal antibody rabbit anti-human thymocyte globulin (ATG), nondepleting human anti-interleukin-2 receptor (CD25) monoclonal antibody daclizumab (Dac) or basiliximab, or lymphodepleting humanized anti-CD52 monoclonal antibody alemtuzumab) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Its goal was to reduce/avoid both calcineurin inhibitor's nephrotoxicity and the incidence of acute/chronic rejection, leading to more favorable longer term patient and graft survival.…”

Similar Survival in Patients Following Heart Transplantation Receiving Induction Therapy Using Daclizumab vs. Basiliximab

“…16 In addition, a large head-to-head comparison of basiliximab (n=107) and daclizumab (n=105) was performed in a randomized prospective analysis of deceased donor renal transplant recipients. 17 In that study, biopsy-confirmed ACR at 12 months was found in 11 (10.3%) basiliximab recipients and in 10 (9.5%) daclizumab patients. Patient survival 1 year after transplantation was 97.2% and 97.1% in the basiliximab and daclizumab groups, respectively.…”