Using a multicenter propensity-score-matched method, this study systematically evaluated graft and infection-related outcomes in simultaneous liver–kidney transplant recipients who did or did not receive basiliximab induction therapy. The study found that patients not receiving basiliximab had similar graft rejection rates compared to those who did, but experienced higher risks of viral infections, particularly cytomegalovirus (CMV) and Epstein–Barr virus (EBV). Additionally, the non-basiliximab group had a higher proportion of patients undergoing liver biopsies, likely reflecting increased clinical vigilance for rejection.
Literature Overview
The article "Evaluating the Role of Basiliximab Induction in Simultaneous Liver–Kidney Transplantation: A Multicenter Propensity-Score-Matched Analysis", published in the journal Antibodies, reviews and summarizes the role of basiliximab as an induction immunosuppressant in simultaneous liver–kidney (SLK) transplantation, focusing on graft rejection and infectious complications. Using propensity-score matching, the study analyzed 292 SLK recipients who received basiliximab and 292 who did not, evaluating graft and infection-related outcomes at 3, 6, and 12 months post-transplant.
Background Knowledge
Simultaneous liver–kidney transplantation (SLK) is typically used for patients suffering from end-stage liver disease combined with chronic kidney failure. Due to the liver graft's immunoprotective properties, SLK recipients generally have lower rejection rates compared to kidney transplantation alone. However, induction immunosuppressive regimens in SLK still vary significantly across centers, with some using basiliximab while others rely on steroid monotherapy. The purpose of this study is to evaluate the efficacy of basiliximab in SLK, particularly its impact on graft rejection, infection risk, and early graft dysfunction. The TriNetX database was employed for this analysis, which is widely used in transplant research due to its standardized data and quality control mechanisms, enabling real-world evidence generation. The study also focused on graft function, liver and kidney biopsy rates, and viral infections such as cytomegalovirus (CMV) and Epstein–Barr virus (EBV), aiming to better understand the potential benefits or risks of induction regimens in SLK recipients.
Research Methods and Experiments
This study used the TriNetX database to identify patients who underwent their first simultaneous liver–kidney transplantation between 2000 and 2020. A total of 292 matched pairs were analyzed to compare graft and infectious outcomes between patients who received basiliximab induction and those who did not. The primary endpoints included graft rejection, graft function, infections (including CMV, EBV, pneumonia, sepsis, and pyelonephritis), and length of hospital stay at 3, 6, and 12 months post-transplant. The matching variables included 71 factors such as demographic characteristics, underlying disease etiology, severity of illness, and immunologic sensitization risk, ensuring both groups were well-balanced at baseline.
Key Conclusions and Perspectives
Research Significance and Prospects
The findings suggest that basiliximab induction may not be essential in simultaneous liver–kidney transplantation, especially for patients with low immunologic risk. Its use may result in reduced early tacrolimus exposure and lower biopsy rates, but no significant improvement in infection risk. Future studies may explore the potential benefits of basiliximab in specific high-immunologic-risk subgroups and develop more tailored immunosuppressive strategies to improve long-term outcomes for SLK recipients.
Conclusion
This propensity-score-matched analysis evaluated the role of basiliximab as an induction immunosuppressant in simultaneous liver–kidney transplantation. Compared to patients who received basiliximab, those who did not showed higher rates of CMV and EBV infections in the early post-transplant period and were more likely to undergo liver biopsies, but did not show significant differences in graft rejection or dysfunction. These findings suggest that basiliximab may not significantly improve graft outcomes in SLK recipients but may reduce steroid exposure and lower the risk of viral infections. Additionally, the study found lower early tacrolimus trough concentrations in the basiliximab group, potentially linked to its induction effect. These results support avoiding routine use of basiliximab in SLK recipients with low immunologic risk, while reserving it for high-risk patients. Further prospective studies are needed to validate the efficacy of such a strategy in different patient subgroups.
