Introduction: Basilixiab is a fixed-dose IL-2 receptor antagonist that is used for non-lymphodepleting induction therapy. The impact of obesity on basiliximab pharmacokinetics and pharmacodynamics is largely unknown, as initial clinical trials in transplant patients largely excluded this population. The purpose of this study is to compare clinical outcomes in obese versus non-obese renal transplant (RTx) recipients undergoing basiliximab induction.

Methods: Adult RTx recipients who received basiliximab induction between 1/1/2009-9/30/2015 were included. Patients were defined as obese (BMI > 30 kg/m2) or non-obese. Patients were maintained on a combination of calcinurin inhibitor and mycophenolic acid, and all received a 5-day steroid taper at RTx. Patients were deemed to have experienced acute rejection if they had either biopsy-proven rejection or had received empiric treatment for rejection in lieu of allograft biopsy. The primary outcomes was to compare the incidence of acute rejection (AR) at 3, 6, and 12 months post-RTx. Secondary outcomes included patient and graft survival, eGFR, and infection rates.

Results: A total of 213 patients (obese = 91, non-obese = 122) were analyzed. A majority of the patients were Hispanic (51.2%), male (63.4%), and recipients of living-donor RTx (79.3%). Average patient BMI was significantly different (obese 37.59 kg/m² vs. non-obese 24.55 kg/m², p<0.001). Demographics are detailed in Table 1. Incidence of AR was similar at 6 and 12 months (p = 0.12 for both). Number of AR episodes was lower in the non-obese group vs. the obese group at 6 months (32 vs. 39, p=0.03) and at 12 months (36 vs. 51, p=0.01). GFR was significantly higher in the non-obese group at 1, 3, 6, and 12 months post-RTx. Table 2 details pertinent clinical outcomes.

Conclusion: After basiliximab induction, obese patients had significantly more rejection episodes and lower eGFR compared to non-obese patients. These results warrant the need to study basiliximab pharmacokinetics, pharmacodynamics, and outcomes in obese transplant recipients.

CITATION INFORMATION: Benken J., Kane C., Lichvar A., Benedetti E. Differences in Rejection and Clinical Outcomes in Obese versus Non-Obese Renal Transplant Recipients Receiving Basiliximab Induction Immunosuppression Am J Transplant. 2017;17 (suppl 3).

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