title: Are there real advantages of induction therapy with basiliximab in renal transplantation?
abstract: BACKGROUND
  Randomized clinical trials have supported the use of interleukin-2 receptor (IL-2R) antagonists as induction therapy in renal transplantation. This strategy has reduced the incidence of acute rejection episodes (ARE) but not improved graft survival. Our objective was to investigate the impact of induction therapy using the IL-2R antagonist basiliximab, as compared with no induction therapy, on relevant clinical outcomes-initial length of stay, incidence of ARE, long-term graft function, and graft survival.
  
  
  METHODS
  We retrospectively reviewed the medical records of patients transplanted in a tertiary care center between 1996 and 2011. We selected patients who received cyclosporine, mycophenolate mofetil, and prednisolone (n = 334) to classify as: no induction therapy (n = 131; group 1); induction therapy with basiliximab (n = 203; group 2). Estimated glomerular filtration rate (eGFR) was assessed with the 4-variable Modification of Diet in Renal Disease (MDRD) equation.
  
  
  RESULTS
  Mean follow-up was 72.7 ± 35.4 months. Patients who received basiliximab had a shorter mean hospital stay (19.2 versus 22.5 days; P = .02), lower incidence of ARE (10.8% versus 23.7%; P = .02) and better graft function post transplantation at 12 months (mean eGFR 59.4 ± 18.4 versus 54.8 ± 18.7 mL/min/1.73 m(2); P = .015) and 5 years (mean eGFR 64.1 ± 21.5 versus 55.4 ± 19.6 mL/min/1.73 m(2); P = .009). On multivariate analysis, induction therapy with basiliximab was independently associated with a lower incidence of ARE and better graft function at 1 and 5 years after transplantation. There was no difference in 5-year graft survival between the two groups (log-rank: P = .54).
  
  
  CONCLUSIONS
  Induction therapy with basiliximab was associated with a reduced incidence of ARE and better long-term graft function but no difference in 5-year graft survival.
authors.affiliation: Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Teixeira
authors.forename: Z
authors.initials: Z
authors.lastname: El Bouazzaoui
authors.forename: J
authors.initials: J
authors.lastname: Guerra
authors.forename: M
authors.initials: M
authors.lastname: Raimundo
authors.forename: A
authors.initials: A
authors.lastname: Santana
authors.forename: M C
authors.initials: MC
authors.lastname: Mil-Homens
authors.forename: A
authors.initials: A
authors.lastname: Gomes da Costa
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000077552:Basiliximab; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012189:Retrospective Studies
chemical_list: D000911:Antibodies, Monoclonal; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab