Basiliximab with delayed introduction of calcineurin inhibitors as a renal‐sparing protocol following liver transplantation in children with renal impairment

Abstract

Renal impairment is frequently compromised in patients with end-stage liver disease and is associated with increased long-term mortality post-LT. In contrast to CNI, basiliximab is an immunosuppressive agent with minimal nephrotoxic potential. This study reviews the experience of a single pediatric liver transplant center's renal-sparing approach with the use of basiliximab and MMF to compensate for delayed entry of CNI in children with renal impairment at the time of organ availability. There were no differences in renal function between pediatric patients with and without pre-LT renal impairment within the first year (cGFR: 135 mL/min/1.73 m2 vs. 144 mL/min/1.73 m2 ; p = 0.56) or at 5-8 yr following LT, (129 mL/min/1.73 m2 vs. 130 mL/min/1.73 m2 ; p = 0.97). In addition, there was no difference in ACR rates (50% vs. 43%, p = 0.62) between patients in the basiliximab group and those patients receiving standard CNI and steroid strategies. The utilization of a renal-sparing approach with basiliximab alongside delayed entry and lower early target trough levels of CNI in children with renal impairment at the time of LT is safe and maintains excellent long-term kidney function.

Efficacy and safety of basiliximab in liver transplantation for patients with hepatitis B virus-related diseases: a single centre study

“…In this study, the major differences between the two immunosuppressive protocols for perioperative management were the application of basiliximab and thereafter a delay of tacrolimus, granting extra time for the recovery or stabilisation of renal function. The protocols are consistent with previous studies with basiliximab administration, which allow for a delay in initiation and a lower dosage of tacrolimus in both adult and child LT, could preserve renal function for LT recipients, without an unfavourable effect on the complication incidence . Therefore, it was demonstrated that basiliximab is effective in sparing renal function without increasing the incidence of rejection and infection.…”

“…Currently, most available studies of basiliximab utilisation in LT were conducted in non-hepatitis B patients, though hepatitis B is still considered to be quite prevalent in China (1,(9)(10)(11)(12)(13)(14). The application of basiliximab focusing on LT recipients with HBVrelated diseases has rarely been investigated around the world.…”

Immunosuppression in pediatric liver transplant recipients: Unique aspects

“…Basiliximab, a chimeric anti‐interleukin (IL) 2 receptor antibody, has been used in induction of immunosuppression. Its use is associated with a lower incidence of acute cellular rejection and can reduce the use or delay the introduction of CNIs, which is particularly helpful in patients with renal dysfunction …”

“…Its use is associated with a lower incidence of acute cellular rejection and can reduce the use or delay the introduction of CNIs, which is particularly helpful in patients with renal dysfunction. (48)…”

Conversion from tacrolimus to sirolimus as a treatment modality in de novo allergies and immune‐mediated disorders in pediatric liver transplant recipients

“…All study patients followed institutional protocols for immunosuppression which were largely unchanged during the duration of the study period 23 . Briefly, the standard induction immunosuppression comprised dual therapy with tacrolimus and corticosteroids, with a taper to discontinuation of steroids by 3 months post‐transplant.…”