A heart transplant center experience with basiliximab induction strategies: A double edged sword?

• DOI: 10.1111/ctr.15307
• Publication Date: 2024-04-03T12:38:34Z
• Authors: Luise Holzhauser; Maxwell Norris; Maria Molina; Susan Chambers; Swethika Sundaravel; Eman Rashed; Ketan Gala; Tara Fallah; Therese Bittermann; Nosheen Reza; Teresa Wang; Pavan Atluri; Lee Goldberg; Rhondalyn McLean; Eliot Peyster
• Keywords: SWORD; Basiliximab; Center (category theory)

Abstract Background The use of induction immunosuppression for heart transplantation (HT) is debated given the uncertain benefit and potential risks infection malignancy. Methods This a retrospective single‐center analysis 475 consecutive HT recipients from 2003 to 2020 grouped by with basiliximab group (BG) no (NBG). Subgroup era compared pre‐2016 standard‐basiliximab (BX) 2016–2020 selective‐BX as part calcineurin‐inhibitor‐sparing regimen. Results When adjusted confounders (sex, age, PRA, eGFR), BG was less likely have acute cellular rejection (ACR) (OR.42, p < .001), but had more antibody mediated (AMR) (OR 11.7, .001) cardiac allograft vasculopathy (CAV) 3.8, = .04). There difference between NBG in incidence malignancies or infections. stratified (pre‐2016 vs. 2016–2020), ACR remained common than (36% 50%, .045) groups, while AMR (9.7 0% .005). significant conditional survival comparing pre‐and post‐2016 (HR 2.20 (95% CI.75–6.43); however, both significantly higher mortality 2.37 [95% CI 1.02–5.50) HR 2.69 1.08–6.71), .045 and.03, respectively]. Conclusion Basiliximab reduces increases risk AMR, CAV, may be associated increased mortality. Mechanistic studies are needed describe T‐cell‐escape mechanism enhanced humoral immunity.