*Purpose: Due to nephrotoxic effects of tacrolimus, previous studies have evaluated the utility of basiliximab to delay or reduce tacrolimus for renal preservation in orthotopic liver transplant (OLT) recipients. Most robust studies thus far have been in the setting of steroid maintenance. At our institution, 1-2 doses of basiliximab are given to patients to either delay the introduction or reduce the exposure of tacrolimus depending on pre- or immediate post-transplant renal dysfunction.

*Methods: A retrospective cohort study was performed of adult OLT recipients transplanted between April 1, 2019 and March 31, 2021. Multiorgan transplants and death during index hospitalization were excluded. Patients were classified based on receiving 0, 1, or 2 doses of basiliximab. Decision to give 1 or 2 doses depended on renal recovery in early post-OLT period. All patients received tacrolimus, mycophenolate, and a 7-day course of corticosteroids. Per protocol, patients that receive 2 doses of basiliximab have a lower tacrolimus goal of 6-8 ng/dL (vs. 8-10 ng/dL). The primary outcome was the incidence of acute rejection (AR). Secondary outcomes included differences in renal function and patient and allograft survival.

*Results: A total of 266 patients were included (n=132 in 0 dose; n=35 in 1 dose; n=99 in 2 dose basiliximab groups). Tacrolimus was initiated at a mean of 1.8, 2.9, and 3.3 days in the 0, 1, and 2 basiliximab groups. The 14-day tacrolimus trough was lower in the 2-dose group (10.7, 9.7, and 8.2 ng/mL) and followed this trend out to day 30 (~9 ng/mL in the 0 and 1 dose groups vs ~7 ng/mL in the 2-dose group). There was no difference in the incidence of AR both early post-OLT (5.3% vs 2.9% and 3%; p=0.637) and within 1-year (17.4%, 17.1%, and 14.1%; p=0.787) in patients that received 0, 1, or 2 doses of basiliximab, respectively. Three patients in both the 0 (2.3%) and 1 (8.6%) dose groups were on renal replacement therapy (RRT) pre-OLT compared to 33 (33.3%) in the 2-dose group. At 1- and 6-months post-transplant, serum creatinine continued to be significantly higher in the 2-dose basiliximab group (1.1, 1.4, 2 mg/dL; p<0.001 and 1.1, 1.4, 2.1 mg/dL; p=0.002), but by 1-year there was no difference (1.2, 1.3, 1.5; p=0.167). There was no difference in the incidence of patient or allograft survival between groups.

*Conclusions: Use of either 1 or 2 doses of basiliximab provided adequate renal protection in OLT recipients at 1-year post-transplant in a steroid-sparing population.

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