Basiliximab (Simulect) in acute tubular necrosis high-risk kidney transplantation.
BACKGROUND
Basiliximab (Simulect) therapy reduces acute rejection episodes in renal transplantation. Posttransplant acute tubular necrosis (ATN) is a predisposing factor for acute rejection and reduced graft survival. Anti-lymphocyte antibodies have been used to delay the use of calcineurin antagonists in patients receiving cadaveric renal transplants and to prevent acute rejection episodes. The aim of our study was to learn about the effects of Simulect on ATN in high-risk cadaveric renal transplantation recipients.


METHODS
We studied 93 patients including, 45 who received Simulect (20 mg before transplantation and 20 mg at day 4 posttransplant and 48 patients who did not receive Simulect. All patients received mycophenolate mofetil, steroids, and cyclosporine (46%) or tacrolimus (54%). We defined ATN as the need for dialysis during the first week after transplantation. Risk factors for ATN were: cold ischemia time, donor and recipient age, donor cause of death as stroke, HLA matching, and panel-reactive antibodies.


RESULTS
Among 54 patients who experienced ATN, 44% were in the Simulect group and 71% in the other group (P = .01). In the regression analysis, Simulect was shown to be a protective factor: 0.19 (0.05 to 0.62). Presence of de novo diabetes was more frequent in the group that did not receive Simulect (16 [33%] vs 6 [13%]; P = .02). Acute rejection episodes were similar in both groups: 2.5% in the Simulect group versus 4% in the other group (P = .34). CMV infections occurred in 15 patients (33%) from the Simulect group and in 20 patients (42%) in the other group. Seven patients died in the Simulect group, and five patients died in the other group. In general, Simulect was well tolerated and the degree of complications was similar in both groups.


CONCLUSIONS
Simulect reduced the incidence of ATN among patients receiving a high-risk renal graft. It was well tolerated and no adverse effects were observed. The use of Simulect should be considered for patients receiving renal grafts at high risk for ATN.
Rivera
C Fernández
CF
Nephrology Department, Hospital Juan Canalejo, La Coruña, Spain. constantino_rivera@canalejo.org
Hernández
A Alonso
AA
Verdejo
P Villaverde
PV
García
J Oliver
JO
Rego
S Cillero
SC
Cañedo
F Valdés
FV
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000077552:Basiliximab; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D007683:Kidney Tubular Necrosis, Acute / Q000188:drug therapy* / Q000276:immunology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012044:Regression Analysis
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab