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Basiliximab Induction with Delayed Calcineurin Inhibitors for High-Risk Lung Transplant Candidates

 Ha Eun Kim  ;  Hyo Chae Paik  ;  Su Jin Jeong  ;  Moo Suk Park  ;  Song Yee Kim  ;  Jin Gu Lee 
 YONSEI MEDICAL JOURNAL, Vol.62(2) : 164-171, 2021-02 
Journal Title
Issue Date
Basiliximab / therapeutic use* ; Calcineurin Inhibitors / therapeutic use* ; Creatinine / blood ; Extracorporeal Membrane Oxygenation ; Female ; Graft Rejection / prevention & control ; Humans ; Immunosuppressive Agents / therapeutic use ; Lung Transplantation* ; Male ; Middle Aged ; Postoperative Complications / drug therapy ; Retrospective Studies ; Risk Factors ; Treatment Outcome
Calcineurin inhibitor ; basiliximab ; immunosuppression ; lung transplantation
Purpose: Calcineurin inhibitor (CNI) use has improved lung transplantation outcomes. However, significant perioperative complications in patients receiving CNI can deteriorate the early course of lung transplantation. To date, there is no consensus regarding the optimal agent for the induction regimen after lung transplantation. We aimed to determine the efficacy of basiliximab induction with delayed CNI initiation in the prevention of acute complications without compromising immunosuppression in high-risk patients. Materials and methods: Between January 2013 and December 2019, 236 patients at a single lung transplant center were retrospectively reviewed. Forty-one patients (17.4%) received basiliximab induction, and 195 patients (82.6%) received a routine triple-drug regimen without induction. The primary endpoint was postoperative acute kidney injury with several other postoperative outcomes as secondary end-points. Results: Preoperatively, the induction group had a higher proportion of patients who were admitted before transplantation (95.1% vs. 47.7%, p<0.001) and received intensive unit care (90.2% vs. 33.8%, p<0.001) and extracorporeal membrane oxygenation (ECMO) (87.8% vs. 20.0%, p<0.001) compared to the non-induction group. No significant differences were observed in the incidence of acute rejection between groups (p=0.657), although lower incidence of postoperative complications, including acute kidney injuries or culture-proven infections, were observed in the induction group. However, the differences were not statistically significant. A subgroup analysis of high-risk and preoperative ECMO support groups showed similar results. Conclusion: Basiliximab induction with delayed CNI initiation for high-risk patients might decrease the incidence of perioperative complications, including acute renal failure, without increasing the risk of acute rejection.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Song Yee(김송이) ORCID logo https://orcid.org/0000-0001-8627-486X
Park, Moo Suk(박무석) ORCID logo https://orcid.org/0000-0003-0820-7615
Paik, Hyo Chae(백효채) ORCID logo https://orcid.org/0000-0001-9309-8235
Lee, Jin Gu(이진구)
Jeong, Su Jin(정수진) ORCID logo https://orcid.org/0000-0003-4025-4542
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