AI Article Synopsis
- - The study analyzes the effects of induction immunosuppression using basiliximab on 475 heart transplant recipients from 2003-2020, comparing outcomes between those who received basiliximab (BG) and those who did not (NBG).
- - Results show that while basiliximab is linked to a lower rate of acute cellular rejection (ACR), it corresponds with higher instances of antibody-mediated rejection (AMR) and cardiac allograft vasculopathy (CAV), with no significant difference in infections or cancer risk between the two groups.
- - The findings suggest that although basiliximab is effective in reducing ACR, it may lead to increased mortality and other complications, warranting
Article Abstract
Background: The use of induction immunosuppression for heart transplantation (HT) is debated given the uncertain benefit and potential risks of infection and malignancy.
Methods: This is a retrospective single-center analysis of 475 consecutive HT recipients from 2003 to 2020 grouped by use of induction with basiliximab group (BG) and the no basiliximab group (NBG). Subgroup analysis by era compared pre-2016 standard-basiliximab (BX) induction and 2016-2020 with selective-BX use as part of a calcineurin-inhibitor-sparing regimen.
Results: When adjusted for confounders (sex, age, PRA, eGFR), the BG was less likely to have acute cellular rejection (ACR) (OR.42, p < .001), but had more antibody mediated rejection (AMR) (OR 11.7, p < .001) and more cardiac allograft vasculopathy (CAV) (OR 3.8, p = .04). There was no difference between BG and NBG in the incidence of malignancies or infections. When stratified by era (pre-2016 vs. 2016-2020), ACR remained less common in the BG than the NBG (36% vs. 50%, p = .045) groups, while AMR remained more common (9.7 vs. 0% p = .005). There was no significant difference in conditional survival comparing pre-and post-2016 NBG (HR 2.20 (95% CI.75-6.43); however, both pre-2016 BG and post-2016 BG have significantly higher mortality (HR 2.37 [95% CI 1.02-5.50) and HR 2.69 (95% CI 1.08-6.71), p = .045 and.03, respectively].
Conclusion: Basiliximab reduces the incidence of ACR but increases the risk of AMR, CAV, and may be associated with increased mortality. Mechanistic studies are needed to describe a potential T-cell-escape mechanism with enhanced humoral immunity.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11129338 | PMC |
| http://dx.doi.org/10.1111/ctr.15307 | DOI Listing |
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