Standard induction with basiliximab versus no induction in low immunological risk kidney transplant recipients: study protocol for a randomized controlled trial

Ajlan, Aziza; Aleid, Hassan; Ali, Tariq; Joharji, Hala; Almeshari, Khalid; Nazmi, Ahmed; Shah, Yaser; DeVol, Edward; Alkortas, Dalal; Alabdulkarim, Zinah; Broering, Dieter; Alahmadi, Ibrahim; Ullah, Asad; Alotaibi, Anwar; Al‐Jedai, Ahmed

doi:10.1186/s13063-021-05253-1

Cited by 2 publications

(1 citation statement)

References 35 publications

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“…However, retrospective data from other centers could not have been included as their total ATG dose is considerably higher. Also, based on recent improvements in detecting anti-HLA immunogenicity, determination of low-risk kidney transplant recipients (i.e., total absence of significant anti-HLA antibodies) is now more accurate, and some transplant teams are currently conducting clinical trials to assess the benefit of induction therapy in this low-risk population (33). In our cohort, ATG induced a better prevention of BPAR than Basiliximab, which supports the pursuit of induction therapy for these patients; which however needs to be tailored to provide a very low dose of ATG.…”

Section: Discussionmentioning

confidence: 99%

Very Low Dose Anti-Thymocyte Globulins Versus Basiliximab in Non-Immunized Kidney Transplant Recipients

Masset

Kerleau²,

Blancho³

et al. 2023

Transpl Int

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The choice between Basiliximab (BSX) or Anti-Thymocyte Globulin (ATG) as induction therapy in non-immunized kidney transplant recipients remains uncertain. Whilst ATG may allow steroid withdrawal and a decrease in tacrolimus, it also increases infectious complications. We investigated outcomes in non-immunized patients receiving a very low dosage of ATG versus BSX as induction. Study outcomes were patient/graft survival, cumulative probabilities of biopsy proven acute rejection (BPAR), infectious episode including CMV and post-transplant diabetes (PTD). Cox, logistic or linear statistical models were used depending on the studied outcome and models were weighted on propensity scores. 100 patients received ATG (mean total dose of 2.0 mg/kg) and 83 received BSX. Maintenance therapy was comparable. Patient and graft survival did not differ between groups, nor did infectious complications. There was a trend for a higher occurrence of a first BPAR in the BSX group (HR at 1.92; 95%CI: [0.77; 4.78]; p = 0.15) with a significantly higher BPAR episodes (17% vs 7.3%, p = 0.01). PTD occurrence was significantly higher in the BSX group (HR at 2.44; 95%CI: [1.09; 5.46]; p = 0.03). Induction with a very low dose of ATG in non-immunized recipients was safe and associated with a lower rate of BPAR and PTD without increasing infectious complications.

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Section: Discussionmentioning

confidence: 99%

Very Low Dose Anti-Thymocyte Globulins Versus Basiliximab in Non-Immunized Kidney Transplant Recipients

Masset

Kerleau²,

Blancho³

et al. 2023

Transpl Int

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Role of Induction in a Haplomatch, Related, Low-risk, Living-donor Kidney Transplantation with Triple Drug Immunosuppression: A Single-center Study

Jha

Bansal

Sharma

et al. 2023

Indian Journal of Nephrology

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Introduction: The role of induction in low-risk, living-donor kidney transplants being treated with tacrolimus, mycophenolate mofetil, and prednisolone is debatable. Methods: This was a retrospective study that consisted of patients undergoing living kidney transplantation between February 2010 and June 2021 with a related haplomatch donor, with maintenance immunosuppression of tacrolimus, mycophenolate mofetil, and prednisolone. High-risk transplants, such as second or more transplants, immunologically incompatible transplants, and steroid-free transplants, were excluded. Patients were divided into three groups: no induction, basiliximab induction, and thymoglobulin induction, and the outcomes of all three were compared. Results: A total of 350 transplants were performed. There was a significant difference in the recipient sex distribution (P = 0.0373) and the number of preemptive transplants (P = 0.0272) between the groups. Other parameters were comparable. Biopsy-proven acute rejection (BPAR) was significantly less frequent in the thymoglobulin group than in the no-induction (5.3% vs. 17.5%; P = 0.0051) or basiliximab (5.3% vs. 18.8%; P = 0.0054) group. This persisted even after we performed multivariate regression analysis (thymoglobulin vs. no-induction group, P = 0.0146; thymoglobulin vs. basiliximab group, P = 0.0237). There was no difference in BPAR between the basiliximab and no-induction groups. There were no differences in other outcomes between the groups. Conclusions: In a low-risk haplomatch, related, living-donor kidney transplant on tacrolimus, mycophenolate mofetil, and prednisolone, BPAR was significantly lower with thymoglobulin as opposed to no induction or basiliximab induction with a similar short-term patient and death-censored graft survival and infection rates. Basiliximab did not provide any benefit over no induction.

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Standard induction with basiliximab versus no induction in low immunological risk kidney transplant recipients: study protocol for a randomized controlled trial

Cited by 2 publications

References 35 publications

Very Low Dose Anti-Thymocyte Globulins Versus Basiliximab in Non-Immunized Kidney Transplant Recipients

Very Low Dose Anti-Thymocyte Globulins Versus Basiliximab in Non-Immunized Kidney Transplant Recipients

Role of Induction in a Haplomatch, Related, Low-risk, Living-donor Kidney Transplantation with Triple Drug Immunosuppression: A Single-center Study

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