Introduction: Renal dysfunction (RD) before and following liver transplantation is a known complication that affects recipient and graft survival. Calcineurin inhibitors (CNIs) are the primary immunosuppression in transplants but are associated with an increased incidence of RD. Short-term antibody induction with delayed CNI introduction has been one strategy for protecting renal function.
Methods: This was a retrospective observational study comparing the postoperative outcome of the use of basiliximab (bax) in recipients with perioperative renal dysfunction between July 2019 and December 2022.
Result: A total of 427 LDLTs were performed during the study period from 25th July 2019 to 29th December 2022. The incidence of HRS-AKI and post-operative AKI was 17.1% and 5.8% respectively.  Non-alcoholic steatohepatitis was the most common etiology (33.3% vs 37.5%, p=0.7). The mean Child-Turcotte-Pugh score (10.42 vs 10.64) and Model for End-Stage Liver Disease Sodium score (24.26 vs 23.26) were similar. Preoperative peak serum creatinine level was 1.27±0.45mg/dl in the bax group and 1.46 ± 0.62 mg/dl in the non-bax group (table 3, Fig 1, p=0.08). The lowest preoperative mean eGFR in the bax group was 69.6±37.77 ml/min/1.73m2 and 57.2±27.85 ml/min/1.73m2 in the non-bax group (Fig 2, p=0.06). The Basiliximab group had more RD immediately before transplant (day minus one) (mean creatinine 1.15±0.21 vs 0.93±0.27, p<0.0001 and eGFR 68.56±15.31 vs 89±38.19, p=0.0016). There was a significant difference in the tacrolimus initiation and first 3 mean tacrolimus trough concentration (TC) (p=0.002, 0.04, 0.02, and 0.07 respectively) and overall TC was less in the bax group. Recipients without preoperative acute kidney injury (AKI) who developed AKI in the postoperative period and received bax, had significantly better serum creatinine (p=0.04) as well as eGFR (p=0.047) at 6 months. The incidence of infections was significantly higher in the non-bax group (28.5% vs 9.5% p value=0.02). Two patients (4.7%) required dialysis in the bax group. Acute cellular rejection (clinical) was higher in the non-bax group (21.4% vs 12%, p=0.28). No significant difference was found in other post-operative complications.
Conclusion: Basiliximab with delayed introduction of tacrolimus is a safer and effective regimen in liver transplant recipients with post-operative renal dysfunction without increasing risk of infections. Its renal sparing effect is significantly higher in recipients who had developed AKI only in the postoperative period.