Single-Dose Basiliximab Induction in Low-Risk Renal Transplant Recipients

OBJECTIVES To compare the efficacy of a single dose of basiliximab with two doses in preventing acute rejection in selected low-risk renal transplant recipients. METHODS This observational study of 760 kidney transplant recipients considered to be at low immunologic risk (peak panel reactive antibody less than 10%) compared patient and graft outcomes following a single-dose versus a two-dose regimen of basiliximab. MAIN RESULTS No differences were found in patient survival (92% vs 92%, p= 0.6), graft survival (86% vs 83%, p= 0.2), acute rejection (cellular [4% vs 7%, p= 0.2], antibody-mediated rejection [19% vs 19%, p= 0.9]), or opportunistic infections (34% vs 30%, p= 0.3) between the single versus two-dose regimens, respectively. In multivariate analyses, the number of doses of basiliximab was not associated with acute rejection or patient/graft survival despite adjustment with Cox regression and propensity scores. However, delayed graft function (DGF), donor age older than 65 years, and human leukocyte antigen mismatch of 3 or higher were associated with acute rejection (hazard ratio [HR] 2.64, 1.91, and 1.57, respectively, p= 0.04), and DGF and diabetes were associated with death/ graft loss (HR 2.56 and 1.63, respectively, p= 0.009). PRINCIPAL CONCLUSIONS A single dose of basiliximab is safe and effective for induction in low-risk kidney transplant recipients.