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Last Updated: 2004-09-22 16:00:15 -0400 (Reuters Health)
By Karla Gale

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 2002.

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 transplantation.

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.