title: Timing of basiliximab induction and development of acute rejection in lung transplant patients.
abstract: BACKGROUND
  Acute rejection affects more than 36% of recipients within the first year post-transplantation. The interleukin-2 (IL-2) receptor antagonist basiliximab has been associated with decreased frequency and severity of acute rejection. We investigated whether the timing of induction administration would impact the frequency and severity of acute rejection in the first year after transplantation.
  
  
  METHODS
  In this study we reviewed 119 patients who underwent lung transplantation at Henry Ford Hospital from October 1994 to January 2009. Prior to January 2000 no patients received induction. From January 2000 to March 2006 the initial dose was given after implantation, and from March 2006 to 2009 basiliximab was given prior to implantation. The primary outcome was cumulative acute rejection score (CAR) in the first post-operative year comparing post- vs pre-implant induction.
  
  
  RESULTS
  The CAR score for pre-implant basiliximab was 2.5 ± 2.3. This was significantly lower than CAR score of 4.6 ± 3.9 in the post-implant group (p = 0.025). The no-induction group had the highest CAR score at 6.3 ± 3.8 (p = 0.077 compared with the post group). The mean follow-up times in the post and pre group were 5.9 ± 2.3 and 2.3 ± 0.7 years, respectively (p < 0.001). There was no difference in freedom from bronchiolitis obliterans syndrome (BOS), survival or invasive infections between pre- and post-implant induction groups.
  
  
  CONCLUSIONS
  Basiliximab prior to implant is associated with a lower cumulative acute rejection score over 1 year compared with induction post-implantation. Despite a lower cumulative acute rejection score, there was no significant difference in freedom from BOS or survival.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan 48202, USA.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Swarup
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Allenspach
authors.forename: Hassan W
authors.initials: HW
authors.lastname: Nemeh
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Stagner
authors.forename: Alan D
authors.initials: AD
authors.lastname: Betensley
mesh_terms: D019138:Antibodies, Blocking / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000077552:Basiliximab; D001989:Bronchiolitis Obliterans / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents; D015994:Incidence; D016040:Lung Transplantation; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D015375:Receptors, Interleukin-2 / Q000037:antagonists & inhibitors; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019138:Antibodies, Blocking; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab