*Purpose: Post-transplant complications related to calcineurin inhibitors (CNI) maintenance immunosuppression (MI) may require interim alternative therapies. The goal of this study is to evaluate the safety and efficacy of basiliximab (BAS) when CNI MI is held due to adverse effects (AEs) including renal (RT) and hematologic toxicity (HT) compared to a case-match cohort.

*Methods: This was a retrospective single-center case-match (CM) analysis of lung transplant recipients (LTR) hospitalized between January 2016 and July 2020, found to have CNI related AEs, comparing LTRs receiving BAS for CNI holiday to those who did not. The primary endpoint was rejection free survival (biopsy-proven or presumed rejection) at 6 months post-intervention for toxicity. Additional endpoints include recovery from CNI toxicity, infection, and progression to bronchiolitis obliterans syndrome (BOS). Toxicity analysis was expressed as degree of recovery.

*Results: Forty-four LTRs were included and are described in Table 1. Baseline characteristics were not statistically different. Of LTRs, the BAS group experienced lower rejection free survival (64 % vs 91%) at 6 months, compared to the CM group (p=0.042; Figure 1). The BAS group experienced more infections at 6 months compared to the case-match group (95% vs 82%).

*Conclusions: BAS therapy as an interim CNI holiday may lead to improved long-term toxicity recovery, however an increased risk of rejection must be weighed against these benefits.

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