Basiliximab induction immunosuppression and lung transplant outcomes: Propensity analysis in a multicenter cohort

Basiliximab induction immunosuppression is increasingly employed in lung transplant recipients despite limited prospective evidence to support its use in this population. We sought to determine the relationship between basiliximab induction and development of acute rejection, chronic lung allograft dysfunction, and other clinically relevant outcomes in a multicenter lung transplant cohort with variable induction practice patterns.

We applied propensity-based statistical methods to rigorous, prospectively collected longitudinal data from 768 newly transplanted adult lung recipients at 5 North American centers (368 who received basiliximab induction immunosuppression and 400 who received no induction immunosuppression). Treatment effects were estimated using outcome-specific propensity score regression models, weighted by the outcome-specific overlap weights, and stratified by center strata.

Basiliximab induction immunosuppression was associated with a significant reduction in any grade acute rejection (HR 0.65, 95% CI 0.46-0.92; p=0.015), organizing pneumonia histology (HR 0.38, 95% CI 0.16-0.90; p=0.028), acute lung injury histology (HR 0.28, 95% CI 0.13-0.61; p=0.001), and development of class II donor specific antibodies (HR 0.51, 95% CI 0.27-0.95; p=0.034) within the first posttransplant year. However, there was no significant association between basiliximab and development of chronic lung allograft dysfunction, mortality, or graft loss. For select infections during the first posttransplant year, there was no evidence of a difference in risk between patients who did versus did not receive basiliximab.

Basiliximab induction immunosuppression is associated with a significant reduction in early posttransplant cellular and humoral immune events and lung injury histologies but not chronic lung allograft dysfunction or mortality.