Basiliximab in a triple-drug regimen with tacrolimus and steroids in liver transplantation

Transplant Proc. Jul-Aug 2005;37(6):2611-3. doi: 10.1016/j.transproceed.2005.06.063.

Abstract

Background: Basiliximab, a chimeric monoclonal antibody (mAb) directed against the alpha chain of the interleukin-2 (IL-2) receptor (CD25), has been extensively evaluated as induction therapy for kidney transplant recipients, more frequently in combination with a cyclosporine-based regimen. In this study, we assessed the efficacy and safety of basiliximab in combination with tacrolimus and steroids following liver transplantation.

Methods: One hundred fifty-two liver transplant recipients (141 cadaveric donors and 11 living donors [LRLT]) in the last 4 years were treated with 2 20-mg doses of basiliximab (days 0 and 4 posttransplantation) followed by tacrolimus (0.15 mg/kg/d; 10-15 ng/mL target trough levels) and steroids (500 mg intravenous [IV] bolus at the reperfusion followed by 20 mg orally daily and weaning off in 1 or 2 months). Follow-up ranged from 104 to 1630 days after transplantation (mean, 665 days; SD +/- 442.65; median, 509 days).

Results: Eighty-five percent of patients remained rejection-free during follow-up with an actuarial rejection-free probability of 78% within 3 months. Nineteen patients had 22 episodes of biopsy-proven acute cellular rejection (ACR). Actuarial patient and graft survival rates at 3 years were 86.7% and 75.8%, respectively. Twenty-seven patients (20.6%) experienced 1 episode of sepsis, requiring temporary reduction of immunosuppressive therapy. There was no evidence of CMV infections or side effects related to basiliximab. We observed 2 de novo malignancies, 1 recurrence from an ileal carcinoid tumor and 1 pulmonary recurrence of hepatocellular carcinoma (HCC) in 1 recipient of LRLT.

Conclusions: Basiliximab in association with tacrolimus and steroids is effective prophylaxis of ACR in liver transplant recipients and does not increase the incidence of infections or adverse effects.

MeSH terms

  • Antibodies, Monoclonal / therapeutic use*
  • Basiliximab
  • Cytomegalovirus Infections / epidemiology
  • Cytomegalovirus Infections / pathology
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Graft Rejection / immunology
  • Humans
  • Immunity, Cellular
  • Immunosuppressive Agents / therapeutic use
  • Injections, Intravenous
  • Liver Transplantation / immunology*
  • Methylprednisolone / administration & dosage
  • Methylprednisolone / therapeutic use*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / pathology
  • Prospective Studies
  • Recombinant Fusion Proteins / therapeutic use*
  • Tacrolimus / therapeutic use*
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal
  • Immunosuppressive Agents
  • Recombinant Fusion Proteins
  • Basiliximab
  • Tacrolimus
  • Methylprednisolone