Pre-implantation basiliximab reduces incidence of early acute rejection in pediatric heart transplantation.
BACKGROUND
Basiliximab is an anti-CD25 monoclonal antibody used as induction therapy in solid-organ transplantation. In this study we aim to determine whether pre-operative administration of basiliximab is beneficial in preventing early heart allograft rejection.


METHODS
In this investigation we assess the effect of pre-implantation basiliximab on CD25 count and on acute rejection in children undergoing cardiothoracic transplantation. The notes of all children undergoing cardiothoracic transplantation at the Great Ormond Street Hospital between January 2000 and June 2007 were retrospectively reviewed. One hundred twenty-one heart transplant recipients were included: 29 patients did not receive basiliximab; 33 patients received basiliximab after coming off cardiopulmonary bypass (CPB); and 59 patients received basiliximab prior to organ implantation.


RESULTS
All patients receiving basiliximab had an effectively suppressed CD25 count (<0.2%) on Days 1 and 10 post-transplant. Freedom from Grade 3A or greater rejection in the first year was significantly greater in the pre-implantation basiliximab group than in the post-implantation and no-basiliximab groups (95%, 70% and 72%, respectively; p = 0.02). Induction regimen was the only significant explanatory variable after multivariate Cox regression.


CONCLUSIONS
The results of this study confirm that basiliximab is effective at suppressing CD25 count whether given pre- or post-CPB. Basiliximab before transplantation appeared to reduce acute rejection, whereas post-CPB administration did not suggest similar effects. These findings require independent validation in randomized trials and further studies should seek to mechanistically delineate these observations.
Department of Cardiology, Great Ormond Street Hospital for Children, London, UK. nicholas.grundy@doctors.org.uk
Nicholas
N
Grundy
Jacob
J
Simmonds
Helen
H
Dawkins
Philip
P
Rees
Paul
P
Aurora
Michael
M
Burch
D000208:Acute Disease; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000077552:Basiliximab; D001706:Biopsy; D002648:Child; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D015994:Incidence; D053645:Interleukin-2 Receptor alpha Subunit / Q000276:immunology; D018655:Lymphocyte Count; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012189:Retrospective Studies; D015996:Survival Rate; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors; D014184:Transplantation, Homologous; D006113:United Kingdom / Q000453:epidemiology
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D053645:Interleukin-2 Receptor alpha Subunit; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab