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In Vitro and In Vivo Assessment of T, B and Myeloid Cells Suppressive Activity and Humoral Responses from Transplant Recipients
Published on: August 12, 2017
Low-dose basiliximab induction therapy in heart transplantation
Veraprapas Kittipibul1, Pakpoom Tantrachoti1, Pat Ongcharit2
1Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Low-dose basiliximab induction therapy in heart transplant recipients demonstrated favorable efficacy and safety. This approach allowed delayed calcineurin inhibitor initiation and early corticosteroid weaning in a low-risk population.
Area of Science:
- Immunosuppression in transplantation
- Cardiovascular surgery
- Pharmacology of biologics
Background:
- Induction therapy is crucial for preventing early graft rejection in heart transplantation.
- Optimizing immunosuppression regimens aims to balance efficacy and reduce toxicity.
- Basiliximab, an interleukin-2 receptor antagonist, is used in transplantation, but dose-finding studies are ongoing.
Purpose of the Study:
- To evaluate the efficacy and safety of a modified low-dose basiliximab induction regimen (10 mg on day 0 and day 4) in de novo heart transplant recipients.
- To assess the feasibility of delaying calcineurin inhibitor (CNI) initiation and enabling early corticosteroid weaning with this regimen.
- To determine the incidence of graft failure, acute cellular rejection (ACR), and infections at 1 and 2 weeks, and 1 year post-transplant.
Main Methods:
- Prospective study of 17 consecutive de novo heart transplant recipients.
- Administration of two 10-mg doses of intravenous basiliximab on postoperative days 0 and 4.
- Monitoring of efficacy outcomes (death, graft failure, ACR) and safety outcomes (infections) at specified time points.
- Assessment of CNI initiation timing and corticosteroid weaning strategy.
Main Results:
- No deaths, graft failures, or ISHLT grade ≥2R acute cellular rejections (ACRs) by 2 weeks post-transplant.
- At 1 year, there was 1 (6%) infectious death, no graft failures, 2 (12%) grade 2R ACRs, 6 (35%) asymptomatic cytomegalovirus (CMV) infections, and 4 (25%) treated infections.
- The modified low-dose basiliximab strategy allowed safe delay of CNI initiation and early corticosteroid wean.
Conclusions:
- Modified low-dose basiliximab induction therapy is effective and safe in de novo heart transplant recipients.
- This regimen facilitates delayed CNI initiation and early corticosteroid discontinuation, potentially reducing early CNI-related toxicity.
- Further research may explore optimizing maintenance immunosuppression, including mycophenolate dosing, in conjunction with this induction strategy.
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