Increased risk of rejection after basiliximab induction in sensitized kidney transplant recipients without pre‐existing donor‐specific antibodies – a retrospective study

Abstract

Depleting induction therapy is recommended in sensitized kidney transplant recipients (KTRs), though the detrimental effect of non‐donor‐specific anti‐HLA antibodies is not undeniable. We compared the efficacy and safety of basiliximab and rabbit anti‐thymocyte globulin (rATG) in sensitized KTRs without pre‐existing donor‐specific antibodies (DSAs). This monocentric retrospective study involved all sensitized KTR adults without pre‐existing DSAs (n=218) who underwent transplantation after June 2007. Patients with basiliximab and rATG therapy were compared for risk of biopsy‐proven acute rejection (BPAR) and a composite end‐point (BPAR, graft loss and death) by univariate and multivariate analysis. Patients with basiliximab (n=60) had lower mean calculated panel reactive antibody than those with rATG (n=158) (23.7±24.2 vs 63.8±32.3, p <0.0001) and more often received a first graft (88% vs 54%, p <0.0001) and a transplant from a living donor (13% vs 2%, p= 0.002). Risks of BPAR and of reaching the composite end‐point were greater with basiliximab than rATG (HR=3.63 [1.70‐7.77], p=0.0009 and HR=1.60 [0.99‐2.59], p=0.050, respectively). Several adjustments did not change those risks (BPAR: 3.36 [1.23‐9.16], p=0.018; composite end‐point: 1.83 [0.99‐3.39], p=0.053). Infections and malignancies were similar in both groups. rATG remains the first‐line treatment in sensitized KTR, even in the absence of pre‐existing DSAs.