Evaluation of Single Versus Two‐Dose Basiliximab Induction Therapy in Live‐Donor Liver Transplant

ABSTRACT Background Basiliximab is a high‐cost induction agent typically given as two doses in liver transplant recipients. This study evaluated renal outcomes in live‐donor liver transplant recipients (LDLTRs) with stable renal function at the time of transplant receiving one versus two doses of basiliximab. Methods We retrospectively identified 231 adult LDLTR with a serum creatinine (SCr) <1.5 mg/dL on post‐transplant Day 5. The primary endpoint was a change in SCr from post‐transplant Days 5 to 30 between the groups. Secondary endpoints included incidence of acute kidney injury (AKI), liver rejection, and culture‐positive infections within 3 and 6 months of transplant. Basiliximab‐related cost savings were also evaluated. Results Median change in SCr from post‐transplant Days 5 to 30 was no different between the single‐dose or two‐dose groups (0.1 [IQR: −0.1–0.3] vs. 0.2 [IQR: −0.1–0.4], p = 0.08). Incidence of AKI was 56.9% in the two‐dose group versus 39.0% in the single‐dose group ( p = 0.01). There was no difference in bacterial ( p = 0.40), fungal ( p = 0.59), or viral ( p = 0.78) infections. Acute cellular rejection through 6 months post‐transplant was noted in 9.7% of patients receiving two doses and 6.3% in the single‐dose arm ( p = 0.42). Basiliximab‐related cost savings in the single‐dose arm was ∼$697 863.72 over 159 transplants. Conclusions Single‐dose basiliximab appears to be safe and effective in place of two doses in LDLTR with stable renal function on post‐transplant Day 5. Utilization of a single basiliximab dose significantly reduced medication‐related costs.