Impact of Induction Therapy in Low Immunological Risk Simultaneous Pancreas-Kidney Transplantation

T-cell depleting agents and IL-2 receptor blockers are the most common induction therapies in simultaneous pancreas-kidney transplantation (SPKT), but the optimal choice remains debated. Here, we perform a retrospective, single-center study with SPKT recipients from 2000 to 2023. Basiliximab was used between 2008 and 2013, and thymoglobulin in other periods. Patients with prior transplants, calculated PRA >20%, pre-SPKT Donor-Specific Antibodies or graft primary non-function because technical reasons, were excluded. An Inverse Probability of Treatment Weighting (IPTW) was performed to adjust for confounding variables. 305 SPKT recipients were included, of which 172 (56%) received thymoglobulin and 133 (44%) basiliximab. Recipient (86% vs. 80%), pancreas (86% vs. 83%) and kidney (84% vs. 89%) death-censored graft survival at 20 years were comparable between groups. Basiliximab was not associated with an increased risk of patient death [HR 1.47 (0.69-3.14), P = 0.32], pancreas [HR 1.08 (0.55-2.10), P = 0.83] or kidney graft failure [HR 0.80 (0.38-1.70), P = 0.56] compared to thymoglobulin. Basiliximab did not significantly increase the risk of pancreas [OR 1.49 (0.84-2.63), P = 0.37] or kidney graft rejection [OR 1.31 (0.54-3.15), P = 0.20]. However, it was associated with significantly lower risk of CMV [OR 0.41 (0.23-0.72), P = 0.002] and BK virus infections [OR 0.31 (0.12-0.80), P = 0.02]. No significant difference was found in new-onset malignancy incidence. These results were maintained even after IPTW adjustment. In SPKT recipients with low immunological risk, basiliximab provides comparable long-term patient and graft outcomes to thymoglobulin while reducing the incidence of opportunistic infections.