Role of basiliximab in the prevention of acute cellular rejection in adult to adult living-related liver transplantation: a single center experience || FREE PAPER ||

S Gruttadauria, L Mandalà, D Biondo, M Spampinato, V Lamonaca, R Volpes, G Vizzini, JW Marsh, A Marcos, B Gridelli

Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (IsMeTT), Italy, Palermo, Italy; University of Pittsburgh Medical Center (UPMC) Italy, Palermo, Italy

Abstract: We report our single center experience with the use of basiliximab, a chimeric monoclonal antibody directed against the alpha chain of the interleukin-2 (IL-2) receptor (CD25), in combination with a steroid- and tacrolimus-based regimen in adult to adult living-related liver transplantation (ALRLT). Sixty consecutive ALRLTs were analyzed. All patients received two 20-mg doses of basiliximab (days 0 and 4 after transplantation) followed by tacrolimus (0.15 mg/kg/day; 10–15 ng/mL target trough levels) and a dose regimen of steroids (starting with 20 mg iv, switched to po as soon as the patient was able to eat, and weaned off within 1–2 months). Follow-up ranged from 6 to 1699.4 days after transplantation (mean 517.5 days, SD ± 413.4; median 424 days). Of the recipients, 95% remained rejection-free during follow-up, with an actuarial rejection-free probability of 96.61% within 3 months. Three patients had episodes of biopsy-proven acute cellular rejection (ACR). Actuarial patient and graft survival rates at 3 years were 82.09% and 75.61%. Six patients (10%) experienced sepsis. There was no evidence of cytomegalovirus infections or side-effects related to the basiliximab. We found zero de novo malignancy, although we observed 5 patients with metastatic spread of their primary malignancy during the follow-up. Basiliximab in association with tacrolimus and steroids is effective in reducing episodes of ACR and increasing ACR-free survival after ALRLT.

Keywords: living-related liver transplantation, acute cellular rejection, basiliximab