Clinical-economic impact of the change of protocol for use of basiliximab in liver transplant.

Objective: Evaluation of the clinical and economic impact after the protocol  change of basiliximab use in orthohepatic transplant.

Method: Retrospective study in which all liver transplant patients were included  during the years 2013, 2014 and until February 15, 2015. The study was divided into two stages according to the protocol used: 1) administration of basiliximab  only if factors of previous risk, and 2) administration of the first dose of  basiliximab to all transplant patients and the second dose if it had risk factors.

Results: 83 patients were included, 34 according to protocol 1 and 49 according  to protocol 2. No significant differences were found in the clinical  variables evaluated or in the variables related to health outcomes. Considering  that the percentage of patients without risk factors who received basiliximab was 43% and without differences in the stays, we could estimate an additional cost  for the universal use of basiliximab in orthohepatic transplant of € 21,400.00.

Conclusions: In our population, the protocol change making universal the first  dose of basiliximab has not shown the expected benefits, but an increase in  costs, so the suitability of the new protocol in consensus with the medical team  must be reconsidered. The evidence regarding the use of basiliximab in  orthohepatic transplant remains limited and although its benefit seems clear in  patients with risk factors, especially renal failure, recommendations about its use universally remains controversial.