Abstract: SA-PO507

Basiliximab versus Thymoglobulin Induction for Pancreas Transplant: A Retrospective Comparative Study of Graft and Patient Outcomes

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • El Kassis, Yvonne, Cleveland Clinic, Cleveland, Ohio, United States
  • Zaky, Ziad S., Cleveland Clinic, Cleveland, Ohio, United States
  • Poggio, Emilio D., Cleveland Clinic, Cleveland, Ohio, United States
Background

Induction therapy is common practice following pancreas transplant (PTx). According to the International Pancreas Transplant Registry, ≥90% of PTx recipients treated with induction receive depleting agents (Thymoglobulin aka ATG) whereas <10% get IL2-receptor blockade (Basiliximab). Our center has historically used ATG induction but has more recently favored Basiliximab for simultaneous pancreas kidney transplants (SPK). We sought to retrospectively compare the graft and patient outcomes of SPK and pancreas transplant alone (PTA) recipients treated with either ATG or Basiliximab induction.

Methods

We reviewed all 242 cases of PTx at out institution between 2003 and 2014. Patients who received a pancreas after kidney (51) and those who did not receive induction (15) were excluded. From the remaining 176 patients, 105 received ATG induction at 4.5 mg/kg and 71 got Basiliximab 20mg on POD 0 and 4. Outcomes included 1 and 3-year graft survival, patients' survival, incidence of rejection episodes, time to first rejection episode, viral infections (CMV, BK, and EBV viremias), and malignancies.

Results

Mean duration of follow up was 81.6 ± 3.8 months (m) for the ATG group and 63.6 ± 3.4 for Basiliximab (p<0.01). All patients in the Basiliximab group had received an SPK whereas 44% of those who received ATG induction had a PTA (p<0.01). Maintenance immunosuppression was similar in both groups. Graft survival at 1 and 3 years were 96 and 88% for Basiliximab and 90 and 81% for the ATG group (p 0.05). Patients’ mean survival was not different between both groups (121 ± 6 m for Basiliximab and 142 ± 5 for ATG, p=0.7). There was no statistically significant difference in the incidence of rejection, infections, or malignancies (Table 1).

Conclusion

Basiliximab appears to be a reasonable alternative for induction following SPK, and does not seem to be associated with a higher incidence of rejection, graft failure, or viral infections.

 ThymoglobulinBasiliximabp value
Rejection25 (24%)19 (27%)0.65
Time to first rejection episode (months)23.4 ± 7.613.2 ± 3.90.24
Infections (%)33 (31%)28 (39%)0.27
CMV viremia (%)17 (16%)15 (21%)0.40
BK viremia (%)13 (12%)12 (17%)0.39
EBV viremia (%)10 (10%)6 (8%)0.8
Malignancy (%)9 (9%)7 (10%)0.77