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

Takuya Watanabe, Masanobu Yanase, Osamu Seguchi, Tomoyuki Fujita, Toshimitsu Hamasaki, Seiko Nakajima, Kensuke Kuroda, Yuto Kumai, Koichi Toda, Keiichiro Iwasaki, Yuki Kimura, Hiroki Mochizuki, Eiji Anegawa, Yasumori Sujino, Nobuichiro Yagi, Koichi Yoshitake, Kyoichi Wada, Sachi Matsuda, Hiromi Takenaka, Megumi IkuraKazuki Nakagita, Shin Yajima, Yorihiko Matsumoto, Naoki Tadokoro, Takashi Kakuta, Satsuki Fukushima, Hatsue Ishibashi-Ueda, Junjiro Kobayashi, Norihide Fukushima

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)2212-2223
Number of pages12
JournalCirculation Journal
Volume84
Issue number12
DOIs
Publication statusPublished - 2020
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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