Purpose: Reports of the use of antibody induction to delay the start of calcineurin inhibitor therapy postoperatively in patients with renal insufficiency at the time of liver transplantation have yielded mixed results. Our institution has increased the use of basiliximab induction for this indication. We aimed to review the effects of induction therapy with delayed tacrolimus (TAC) initiation on the resolution of peri-transplantation renal insufficiency.

Methods: We retrospectively reviewed all liver transplants performed between January 2012 to November 2013.Those patients that received two doses of 20mg IV basiliximab were compared to patients that received no antibody induction therapy. The primary endpoint was change in serum creatinine (SCr) in mg/dL at 1 year post-liver transplant. Secondary endpoints included the primary endpoint in a propensity score matched subgroup, incidence of acute rejection, and Hepatitis C (HCV) recurrence, and time to Tac initiation.

Results: 153 patients were included in the study. 43 patients received basiliximab induction and were compared to 110 without antibody induction. Baseline characteristics between the groups did not differ regarding age and sex. There was a higher proportion of patients with alcoholic cirrhosis (p=0.031) and a lower of proportion of HCV diagnosis (p=0.027) in the basiliximab group. The pre-transplant SCr was significantly higher in the basiliximab group (2.6 vs. 1.2, p<0.001). In patients with a SCr at baseline and 12 months, the mean change was -1.0 in the basiliximab group vs. 0.1 in the no induction group, p<0.001. A smaller difference in SCr persisted at 12 months (1.7 vs. 1.2, p=0.01). There were fewer rejections in the basiliximab group (7.0% vs. 16.4%, p=0.191). No difference was seen between the two groups with regards to risk of HCV recurrence. In the propensity score matched subgroup there were 48 patients with a pre-transplant SCr of 2.1 in the basiliximab group and 1.8 in the no induction group, p=0.164. At 12 months, the SCr was 1.4 vs. 1.2 in the basiliximab and no induction group, respectively, and the change from baseline was -0.62 vs. -0.22, p=0.063. A difference was found in the time to Tac initiation in the basiliximab vs. no induction group, 2 vs. 1 days, respectively, p=0.007.

Conclusion: Use of basiliximab induction in patients with renal insufficiency at the time of liver transplant is associated with lower incidence of rejection and potential improvement in renal function.

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