Reuters Health Information (2004-09-22): Basiliximab reduces rejection after liver transplantation
Basiliximab reduces rejection after liver transplantation
Last Updated: 2004-09-22 16:00:15 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Treating patients with
basiliximab when they first receive a liver transplant seems to reduce
episodes of acute cellular rejection and improve survival, results of a
cohort study suggest.
Basiliximab is a monoclonal antibody directed against interleukin 2
receptor, Dr. Ignazio R. Marino and colleagues explain in the September
27 issue of the journal Transplantation. It works by inhibiting
IL-2-driven T-cell proliferation.
"We believe it is wrong to overtreat patients for rejection," Dr.
Marino, a surgeon at Thomas Jefferson University Hospital in
Philadelphia, explained in an interview with Reuters Health. "You
probably will not have rejection but you disrupt other natural
mechanisms in the body."
"Maybe with a small dose of an immunosuppressant with these new
generation drugs you can induce something close to tolerance," he added.
Dr. Marino and his colleagues prospectively followed 50 consecutive
patients in whom liver transplants were performed between 2000 and
Patients were treated with 20 mg of basiliximab on day 0 and day 4.
Methylprednisolone was administered in a standard rapid taper regimen
for the first month and tacrolimus was started within 2 days of
During follow-up of 404 to 1,364 days, 44 patients (88%) remained
free of acute cellular rejection. In contrast, results of a large
retrospective study of 3,026 liver transplantations performed in Italy,
where monoclonal antibodies were not used, revealed a 43.5% rejection
rate. Other reports have put the 1-year rejection rate anywhere from
38% to 68%.
The actuarial survival rate with basiliximab at 3 years was 88%, the
researchers add, which also compares well with the 72.3% survival in
the large retrospective study. Deaths were the result of late graft
failure or sepsis.
There were no instances of lymphoproliferative disorders or
malignancy. The addition of basiliximab did not increase the recurrence
of hepatitis C virus infection or other adverse events.
"We've had very good outcomes using this drug, because most of our
patients are now on only one single drug, which clearly has an
influence on their quality of life," Dr. Marino said. Patients now
require only a low dose of the tacrolimus, thus reducing the risk of
kidney and neurological toxicity and other complications.
He hopes eventually he can wean patients totally from maintenance immunosuppression.