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Published on: August 12, 2017

Comparable outcomes with anti-thymocyte globulins versus basiliximab in kidney transplantation from controlled

Martin Deslais1, Alice Koenig1,2, Fanny Buron1

  • 1Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.

Transplant International : Official Journal of the European Society for Organ Transplantation
|June 17, 2026
PubMed

Insights

Basiliximab is a cost-effective alternative to anti-thymocyte globulin (ATG) for kidney transplants using donation after circulatory death (DCD) grafts in low-risk patients. This study found similar graft outcomes and safety profiles between the two induction therapies.

Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Organ Donation

Background:

  • Donation after circulatory death (DCD) kidney grafts are increasingly used due to organ shortages.
  • DCD grafts have higher rates of delayed graft function (DGF), leading to specific management protocols.
  • The French national protocol recommends hypothermic machine perfusion and anti-thymocyte globulin (ATG) for DCD kidney transplants.

Purpose of the Study:

  • To compare the efficacy and safety of basiliximab versus ATG induction therapy in low immunological risk DCD kidney transplantation.
  • To evaluate the cost-effectiveness of basiliximab as an alternative to ATG in this patient population.

Main Methods:

  • Retrospective analysis of a single-center cohort (n=158) of low-risk DCD kidney transplant recipients (2015-2023).
  • Comparison of outcomes between patients receiving ATG (pre-March 2020) and basiliximab (post-March 2020).
  • Validation of findings in an independent French multicenter cohort (n=506).

Main Results:

  • No significant differences in primary non-function, DGF rates (17% ATG vs. 12% basiliximab), rejection, one-year renal function, or graft survival.
  • ATG was associated with prolonged Epstein-Barr virus (EBV) and BK viremia without increased complications.
  • Basiliximab induction was associated with a 1.7-fold lower cost compared to ATG, with similar hospital stays.

Conclusions:

  • Basiliximab is a viable and cost-effective alternative to ATG for low-immunological-risk DCD kidney transplant recipients.
  • Current evidence does not strongly favor ATG over basiliximab for this specific patient group.
  • This finding supports a potential shift in induction therapy protocols for DCD kidney transplantation.

Keywords:
DCD (donation after circulatory death)antithymocyte globulinbasiliximabdelayed graft functioninduction

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