Influence of Induction Therapy Using Basiliximab With Delayed Tacrolimus Administration in Heart Transplant Recipients ― Comparison With Standard Tacrolimus-Based Triple Immunosuppression ―

Autor: Seiko Nakajima, Masanobu Yanase, Satsuki Fukushima, Sachi Matsuda, Toshimitsu Hamasaki, Takashi Kakuta, Hatsue Ishibashi-Ueda, Yorihiko Matsumoto, Yuto Kumai, Kyoichi Wada, Keiichiro Iwasaki, Hiromi Takenaka, Shin Yajima, Yuki Kimura, Eiji Anegawa, Osamu Seguchi, Koichi Yoshitake, Junjiro Kobayashi, Yasumori Sujino, Norihide Fukushima, Hiroki Mochizuki, Kensuke Kuroda, Megumi Ikura, Tomoyuki Fujita, Nobuichiro Yagi, Kazuki Nakagita, Takuya Watanabe, Naoki Tadokoro, Koichi Toda
Rok vydání: 2020
Předmět:
Zdroj: Circulation Journal. 84:2212-2223
ISSN: 1347-4820
1346-9843
Popis: Background Appropriate indications and protocols for induction therapy using basiliximab have not been fully established in heart transplant (HTx) recipients. This study elucidated the influence of induction therapy using basiliximab along with delayed tacrolimus (Tac) initiation on the outcomes of high-risk HTx recipients.Methods and Results:A total of 86 HTx recipients treated with Tac-based immunosuppression were retrospectively reviewed. Induction therapy was administered to 46 recipients (53.5%) with impaired renal function, pre-transplant sensitization, and recipient- and donor-related risk factors (Induction group). Tac administration was delayed in the Induction group. Induction group subjects showed a lower cumulative incidence of acute cellular rejection grade ≥1R after propensity score adjustment, but this was not significantly different (hazard ratio [HR]: 0.63, 95% confidence interval [CI]: 0.37-1.08, P=0.093). Renal dysfunction in the Induction group significantly improved 6 months post-transplantation (P=0.029). The cumulative incidence of bacterial or fungal infections was significantly higher in the Induction group (HR: 10.6, 95% CI: 1.28-88.2, P=0.029). Conclusions These results suggest that basiliximab-based induction therapy with delayed Tac initiation may suppress mild acute cellular rejection and improve renal function in recipients with renal dysfunction, resulting in its non-inferior outcome, even in high-risk patients, when applied to the appropriate recipients. However, it should be carefully considered in recipients at a high risk of bacterial and fungal infections.
Databáze: OpenAIRE