The long‐term survival of simultaneous pancreas and kidney transplant with basiliximab induction therapy

Abstract

Interleukin-2 receptor (IL2R) antibody has emerged as an attractive induction therapy for organ transplant. However, the long-term outcome of basiliximab induction in simultaneous pancreas and kidney (SPK) transplant remains speculative. We retrospectively analyzed the long-term survivals of 91 consecutive SPK recipients with basiliximab as induction, combination of steroid, tacrolimus (TAC) and mycophenolate acid (MFA)--either mycophenolate mofetil (MMF) or sodium mycophenolate (myfortic) as maintenance. At one, three, five, and seven-yr, the actual patient survival rate were 91.2%, 90.3%, 88.1%, and 88.2%, respectively; kidney graft survivals were 90.1%, 84.7%, 78.6%, and 70.6%, respectively; and pancreas graft survivals were 86.8%, 80.6%, 71.4%, and 58.8% respectively. There was a low incidence of rejection and CMV infection. Basiliximab induction with TAC, MFA, and steroid maintenance therapy can provide excellent long-term outcome for SPK recipients.

Outcomes of Primary Simultaneous Pancreas-kidney Transplants by Induction Agent in the United States

“…The basis for induction therapy choice has primarily been based on experiences from kidney transplants and revolves around r-ATG, alemtuzumab, or nondepletional IL-2RA. 17-19 In 2002, Stratta et al 20 compared IL-2RA induction to no antibody induction and reported a lower composite risk of acute rejection, death, and graft loss with IL-2RA induction in SPK transplant patients. Expanding on the previous findings, Kaufman et al 8 conducted a multicenter, prospective, randomized, open label controlled trial comparing IL-2RA and r-ATG to no induction in SPK recipients.…”

Induction therapy in pancreas transplantation

“…Zhang et al . described 91 SPK transplants performed with 2‐dose basiliximab induction and triple maintenance immunosuppression with steroids, tacrolimus, and mycophenolate without a control group . Again, patient survival was very good at 91% at 1 year, and declined to 88% at 7 years.…”

“…More recently, Dawson et al described effects of rabbit ATG induction on sensitization for future transplants, based a review of UNOS/OPTN data, and found that using no-induction therapy or using IL-2 receptor blockade induction may be risk factors for sensitization to future transplants [31]. Zhang et al described 91 SPK transplants performed with 2-dose basiliximab induction and triple maintenance immunosuppression with steroids, tacrolimus, and mycophenolate without a control group [32]. Again, patient survival was very good at 91% at 1 year, and declined to 88% at 7 years.…”