A heart transplant center experience with basiliximab induction strategies: A double edged sword?
Luise Holzhauser, Maxwell Norris, Maria Molina, Susan Chambers, Swethika Sundaravel, Eman Rashed, Ketan Gala, Tara Fallah, Therese Bittermann, Nosheen Reza, Teresa Wang, Pavan Atluri, Lee Goldberg, Rhondalyn McLean, Eliot Peyster- Transplantation
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.