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Abstract

Objectives: Basiliximab is used alongside tacrolimusbased immunosuppression for routine induction therapy, even for well-matched living-donor renal transplant recipients. Because tacrolimus is a different drug from cyclosporine, this study examined the utility of tacrolimus-based immunosuppression without basiliximab for well-matched living-donor renal transplant recipients. Material and Methods: This prospective study evaluated 36 patients who underwent 1 to 3 human leukocyte antigens mismatched living-donor renal transplants without basiliximab induction therapy between April 2012 and March 2015 (group 1). All transplants were ABO compatible and T-flow negative and were followed until April 2015. Tacrolimus-based triple therapy was used for maintenance immunosuppression. The control group comprised 72 age-and sex-matched patients who underwent 1 to 3 human leukocyte antigens mismatched living-donor renal transplants with basiliximab induction therapy during the same period (group 2). Results: Two patients in group 1 and 12 patients in group 2 had infection,with cytomegalovirus infection and Pneumocystis pneumonia infection occurring only in group 2 and BK virus and urinary tract infection reported in both groups, with a similar incidence. One patient from group 2 had sepsis. Although the incidence of infection tended to be lower in group 1 than in group 2 (5.6% vs 16.7%), the overall incidence of infection was not significantly different (P = .135). In addition, there were no significant differences in incidence of acute rejection between groups 1 and 2 (2.8% vs 4.2%; P = .699). All patients showed stable renal function after treatment. Conclusions: Tacrolimus-based triple drug maintenance immunosuppression without basiliximab might be an optimal treatment choice for individuals undergoing well-matched living-donor renal transplant. Key words: Kidney transplantation, Tacrolimus, Basiliximab IntroductionBasiliximab is a chimeric mouse-human monoclonal antibody specific for the alpha chain (CD25) of the interleukin 2 receptor. When bound to its receptor, interleukin 2 activates intracellular signaling pathways that induce T-cell proliferation and play a key role in triggering transplant rejection. Thus, basiliximab prevents the activation of effector cells that drive alloimmune responses by inhibiting activation of the interleukin 2 receptor. 1 Randomized controlled trials have compared basiliximab with placebo in cases of kidney transplant performed under cyclosporine-based immunosuppression. The incidence of acute rejection was significantly lower in the basiliximab-treated arm, although the incidence of infection and other adverse events was generally similar between the 2 arms. 2,3 These trials showed that basiliximab is routinely used alongside tacrolimus-based immunosuppression as an agent for induction therapy even in patients who have well-matched living-donor renal transplants in Korea. Some centers in other countries omit induction therapy for such transplants, but no prospective study has exam...

Implication of interleukin-2 receptor antibody induction therapy in standard risk renal transplant in the tacrolimus era: a meta-analysis

“…Gavela Martinez et al [22] and Baek et al . [23] showed similar results, with no difference between the groups (P > 0.05). de Sandes-Freitas et al .…”

“…The highest weight in the forest plot analysis was for the article by Gralla and Wiseman [18] [weight 24.09% (95% CI −0.02 to −0.01)] followed by Baek et al . [23] [weight 17.81% (95% CI −0.06–0.08)]. There was evidence of heterogeneity between included studies ( I 2 = 73.6%, P = 0.001).…”

“…[19] and Baek et al . [23] were the only studies in our meta-analysis to assess the risk of NODAT between the groups. Of the studies included in the meta-analysis, Baek et al .…”

“…Of the studies included in the meta-analysis, Baek et al . [23] was the only one to address the risk of CMV infection in transplant patients who receive IL-2R antibody as induction therapy. It found no significant difference in the risk of CMV infection (2.8% in the IL-2R antibody induction group and 0% in the no-induction group).…”