Effect of basiliximab use on the risk of postoperative infection and death after heart transplantation: An observational study

Abstract

Heart transplantation (HT) has become the preferred treatment for end-stage heart disease, but postoperative complications such as infection still threaten the prognosis of HT patients. Basiliximab can help minimize immune rejection. However, there is a lack of relevant information to compare the prognosis of different immunosuppression regimens. This study aimed to investigate the risk factors associated with death and infection after HT surgery. We also provide some insightful information on the administration of basiliximab to improve the prognosis of HT patients. In total, 70 patients were included in this retrospective observational study. All participants underwent primary HT and were administered immunosuppressive agents postoperatively. Of these, 38 received additional basiliximab. There was a 6-month follow-up period after HT during which clinical outcomes were monitored. Logistic regression and cox-proportional hazard regression analyses were performed to determine the relationship between basiliximab use and the clinical outcomes of HT. Logistic regression analysis revealed that basiliximab use (odds ratio [OR] = 0.07, P = .014) was an independent risk factor for death after HT. d-Dimer (OR = 9.05, P = .002) and basiliximab use (OR = 0.15, P = .004) were independent risk factors for death after HT. Moreover, patients treated with basiliximab had shorter hospital lengths of stay (23.58 ± 13.89 vs 39.41 ± 24.43, P = .001) and intensive care unit lengths of stay (4.76 ± 2.85 vs 11.25 ± 5.79, P < .001). Furthermore, patients administered basiliximab had lower rates of death (1 [5.4%] vs 9 [28.1%], P = .007) and infection (6 [15.8%] vs 19 [59.4%], P < .001). The postoperative survival rate (hazard ratio 0.08, 95% confidence interval 0.01–0.65, P = .018) and survival against infection (hazard ratio 0.24, 95% confidence interval 0.09–0.64, P = .004) were significantly higher among patients receiving basiliximab treatment than among those not receiving treatment. Our study showed that basiliximab use was closely associated with the rate of postoperative death and infection after HT. HT patients with additional basiliximab administration as immunosuppressive treatment had a better clinical prognosis.