Is Induction Therapy with Basiliximab Mandatory in Kidney Transplant Recipients with a Low Immunological-Risk Profile?

Background: Induction therapy with basiliximab is recommended in kidney transplant (KT) recipients with a low immunological risk (LIR) profile. Whether basiliximab is associated with a decreased risk of acute rejection (AR) and graft loss is controversial. Methods: In our institution, LIR patients (absence of anti-HLA antibodies before KT) are inducted with basiliximab in case of living-donor KT (LDKT) while deceased-donor KT recipients (DDKT) receive no induction. Maintenance immunosuppression is similar, including a combination of tacrolimus, mycophenolate and steroids.In this single-center retrospective study, all adult LIR patients who underwent KT between 01/01/2015 and 12/31/2022 (excluding ABO-incompatible and multiorgan transplantations) have been included. Results: Of the 471 patients included, 354 received a DDKT (DDKT group) and 117 a LDKT (LDKT group). Patients from the DDKT group were more frequently male, older and received fewer preemptive KT compared to those from the LDKT group. The median (IQR) number of HLA A-B-DR mismatches was 3 (2-3) and 2 (2-4) in the DDKT group and the LDKT group, respectively. Survival free from treated AR was similar in both groups at 6 months, 1 year and 5 years (Figure 1), as was 5-year survival without reaching a composite endpoint of treated AR or graft loss. At 5 years, the incidences of graft loss (p= 0.074) and death (p=0.6) were similar in the DDKT group vs LDKT group. Conclusion: Induction therapy with basiliximab showed no benefit regarding the risk of treated AR or graft loss within 5 years post-KT compared with a strategy without induction therapy in patients with a LIR profile.Figure 1 : Treated acute rejection-free survival in the 5 years after kidney transplantation.