The Use of Long-Term Monthly Basiliximab Infusions as Rescue Maintenance Immunosuppression in Pancreas Transplant Recipients

• Published in: Clinical transplantation 2024-12, Vol.38 (12), p.e70050
• Main Authors: Chen, Jeanne M, Mangus, Richard S, Sharfuddin, Asif A, Powelson, John A, Yaqub, Muhammad S, Adebiyi, Oluwafisayo O, Jan, Muhammad Y, Lutz, Andrew J, Fridell, Jonathan A
• Format: Article
• Language: English
• Subjects: Adult; Basiliximab - therapeutic use; Female; Follow-Up Studies; Graft Rejection - etiology; Graft Rejection - prevention & control; Graft Survival - drug effects; Humans; Immunosuppression Therapy - methods; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - therapeutic use; Infusions, Intravenous; Kidney Transplantation; Male; Middle Aged; Original; Pancreas Transplantation; Postoperative Complications; Prognosis; Recombinant Fusion Proteins - administration & dosage; Recombinant Fusion Proteins - therapeutic use; Retrospective Studies; Risk Factors
• ISSN: 1399-0012; 0902-0063; 1399-0012
• DOI: 10.1111/ctr.70050

This single-center retrospective study was designed to evaluate the use of basiliximab as an alternative rescue maintenance immunosuppression in situations where standard maintenance immunosuppression is not tolerated after a pancreas transplant. All pancreas transplants performed between January 11, 2006, and January 6, 2022, were reviewed. All recipients received rabbit antithymocyte globulin (rATG) induction with tacrolimus + sirolimus maintenance for simultaneous pancreas and kidney (SPK) and additional low-dose mycophenolic acid for pancreas transplant alone (PTA). Basiliximab 40mg IV q 4 weeks was either added to or in replacement of adjunct immunosuppression in cases of medication intolerance. All recipients who received ≥3 months of basiliximab with ≥1 year follow-up were included. 29/557 (5.2%) recipients (5 SPK and 24 PTA) were identified. Median time to switch was 13 months. When compared 1:2 to matched controls on standard immunosuppression, there was no difference in pancreas rejection, allograft loss, or mortality. Eleven recipients had 13 episodes of pancreas rejection at a median of 28 months post conversion. Eight pancreas allografts failed at a median of 28 months post conversion, and there were five deaths-all occurring in PTA, 4/5 occurring ≥1 year after discontinuation of basiliximab. Renal allograft rejection occurred in one SPK and there was one renal allograft loss. Five PTA developed renal failure. Ten remain on basiliximab (2/5 SPK, 8/24 PTA) at a median of 44 months with good pancreas and kidney function; 4 pts > 4 years. Basiliximab can be considered an alternative rescue maintenance strategy in pancreas transplant recipients who failed other conventional agents.