Introduction: Induction immunosuppression decreases the risk for acute rejection and improves graft outcomes in kidney transplant recipients but in the current era of powerful maintenance immunosuppression, role of induction immunosuppression in low immunological risk group of patients is controversial. Hence, this was a suitable research question which was explored by us in an Indian setting. The objective of our study was to evaluate the impact of induction with basiliximab versus no induction therapy on outcomes in low immunological risk kidney transplant recipients (KTRs).
Methods: This study was conducted between May 2013 to May 2019 in a tertiary care centre in eastern India. It was a prospective randomised study where two groups of low immunological risk KTRs were identified, one who did not receive induction therapy and the other who received induction therapy with basiliximab. Low immunological risk KTRs was defined in this study as patients undergoing first transplant, panel reactive antibody <20% and human leucocyte antigen mismatches ≤3. Both the groups were comparable in baseline characteristics and risk factors for acute rejection. Both the groups were followed up for a period of five years and the donor, recipient and transplant characteristics affecting the graft and patient survival in each group were analysed.
Results: A total of 104 low immunological risk kidney transplant recipients were identified with 52 patients who did not receive induction therapy and another 52 patients who received basiliximab. Adjusted risk for delayed graft function was higher (OR 1.69, 95%CI 1.05-3.11, p=0.02) and one year acute rejection was found to be lower (OR 0.53, 95%CI 0.35- 1.08, p= 0.09) in the basiliximab group compared to the group of patients who did not receive induction therapy. Adjusted five year graft survival were similar in both groups. Adjusted five year patient survival was found to be lower (HR 0.42, 95%CI 0.30- 0.74, p= 0.04) in the group that did not receive induction immunosuppression
Conclusion: Perioperative induction with basiliximab in low immunological risk kidney transplant recipients had lower rejection and lower patient death risk.