Evaluation of Single Versus Two-Dose Basiliximab Induction Therapy in Live-Donor Liver Transplant

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-10-22 DOI:10.1111/ctr.70006

Benjamin N. Herrmann, Cody A. Moore, Heather J. Johnson, Abhinav Humar, Kristen A. Shimko

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Abstract

Background

Basiliximab is a high-cost induction agent typically given as two doses in liver transplant recipients. This study evaluated renal outcomes in live-donor liver transplant recipients (LDLTRs) with stable renal function at the time of transplant receiving one versus two doses of basiliximab.

Methods

We retrospectively identified 231 adult LDLTR with a serum creatinine (SCr) <1.5 mg/dL on post-transplant Day 5. The primary endpoint was a change in SCr from post-transplant Days 5 to 30 between the groups. Secondary endpoints included incidence of acute kidney injury (AKI), liver rejection, and culture-positive infections within 3 and 6 months of transplant. Basiliximab-related cost savings were also evaluated.

Results

Median change in SCr from post-transplant Days 5 to 30 was no different between the single-dose or two-dose groups (0.1 [IQR: −0.1–0.3] vs. 0.2 [IQR: −0.1–0.4], p = 0.08). Incidence of AKI was 56.9% in the two-dose group versus 39.0% in the single-dose group (p = 0.01). There was no difference in bacterial (p = 0.40), fungal (p = 0.59), or viral (p = 0.78) infections. Acute cellular rejection through 6 months post-transplant was noted in 9.7% of patients receiving two doses and 6.3% in the single-dose arm (p = 0.42). Basiliximab-related cost savings in the single-dose arm was ∼$697 863.72 over 159 transplants.

Conclusions

Single-dose basiliximab appears to be safe and effective in place of two doses in LDLTR with stable renal function on post-transplant Day 5. Utilization of a single basiliximab dose significantly reduced medication-related costs.

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活体肝移植中单剂与双剂巴西利西单抗诱导疗法的评估

背景：巴利昔单抗是一种高成本诱导药物，通常在肝移植受者中分两次给药。本研究评估了肾功能稳定的活体肝移植受者（LDLTR）在接受一次与两次巴利昔单抗治疗后的肾脏预后：我们回顾性地确定了 231 名成人 LDLTR 的血清肌酐（SCr）结果：从移植后第 5 天到第 30 天，单剂量组和双剂量组 SCr 的中位数变化没有差异（0.1 [IQR: -0.1-0.3] vs. 0.2 [IQR: -0.1-0.4]，p = 0.08）。双剂量组的 AKI 发生率为 56.9%，单剂量组为 39.0%（P = 0.01）。细菌（p = 0.40）、真菌（p = 0.59）或病毒（p = 0.78）感染率没有差异。在接受两剂治疗的患者中，有9.7%的患者在移植后6个月内出现急性细胞排斥反应，而在单剂治疗组中，有6.3%的患者在移植后6个月内出现急性细胞排斥反应（p = 0.42）。在159例移植中，单剂量组与巴利昔单抗相关的成本节约为697 863.72美元：结论：对于移植后第 5 天肾功能稳定的低密度脂蛋白血症患者，单剂量巴利昔单抗似乎可以安全有效地替代双剂量巴利昔单抗。使用单剂量巴利昔单抗可显著降低药物相关费用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.