Basiliximab plus low-dose cyclosporin vs. OKT3 for induction immunosuppression following renal transplantation.
BACKGROUND
Current immunosuppressive therapies are very effective in preventing acute rejection (AR) and graft loss following renal transplantation. Newer agents now make it possible to develop equally efficacious but better tolerated and less toxic strategies. This is especially relevant for our ageing recipients. We now compare the efficacy of basiliximab combined with early low-dose cyclosporin therapy to standard OKT3 induction therapy.


METHODS
In this single-centre study, 100 consecutive recipients of cadaveric kidney transplants from November 1998 to August 2000 were treated with basiliximab combined with early low-dose cyclosporin, reduced steroids and mycophenolate mofetil (MMF). Clinical outcomes at 100 d and 1 yr were compared with a group of 26 patients transplanted from March 1995 to November 1998 who received OKT3, delayed full-dose cyclosporin, high-dose steroids and MMF. Amongst basiliximab treated patients, we compared clinical outcomes in those older and younger than 60 yr.


RESULTS
Both groups were similar except for a shorter cold ischaemic time in the basiliximab group. Length of stay, number of readmissions, total hospitalization days and cytomegalovirus infections were lower in the basiliximab group. Despite a 40% reduction in steroids, basiliximab-treated patients had fewer biopsy-proven episodes of AR (basiliximab 14% vs. OKT3 35%) and required less antilymphocyte antibody therapy. Clinical outcomes including patient and graft survival were no different between groups. Long-term graft survival for patients over 60 yr was limited primarily by mortality.


CONCLUSIONS
Compared with OKT3 induction therapy, the combination of early low-dose cyclosporin and basiliximab is steroid sparing, effective, well tolerated and relatively safe.
Kode
Ravi
R
MCP-Hahnemann University, Philadelphia, PA, University of Pennsylvania, Philadelphia, PA and SUNY-University at Buffalo, Buffalo General Hospital, Buffalo, NY 14203, USA.
Fa
Kosunarty
K
Chowdhury
Shoaib
S
Ranganna
Karthik
K
Fyfe
Billie
B
Stabler
Susan
S
Damask
Anna
A
Laftavi
Mark R
MR
Kumar
Anil Mysore
AM
Pankewycz
Oleh
O
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000077552:Basiliximab; D002102:Cadaver; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D011993:Recombinant Fusion Proteins; D016572:Cyclosporine; D000077552:Basiliximab