Effect of basiliximab on renal function in lung transplant recipients with renal failure
Authors: Umesh Goswami, Kyle Rudser, Roland Brown, Joanne Billings, Naim Issa, Gabriel
Loor, Jordan Dunitz
Purpose: Over 50% lung transplant recipients (LTR) develop renal failure (RF) in 5 years after
transplant. Renal function may improve with dose reduction or cessation of calcineurin inhibitors
(CNI) but few effective alternatives have been evaluated. We hypothesized that the use of
interleukin-2 receptor blocker basiliximab (BXMB) in LTR allows transient dose reduction or
cessation of CNI and results in sustained improvement in renal function without affecting the
graft survival.
Methods: The medical record of all LTR with RF treated with 2 doses of BXMB, 20 mg each 72
hours apart, between April 2011 and July 2014 were retrospectively reviewed. Demographics,
pertinent laboratory values, lung biopsy results and pulmonary function test variables were
collected and analyzed.
Results: A total of 25 LTR with a mean±SD age of 58.0±6.8 years and an estimated glomerular
filteration rate (eGFR) of 39.8±25.1 mL/min/1.73 m2 received BXMB. The mean duration from
transplant to BXMB dose was 18.47±28.7 months. The eGFR values on days 7, 30, 90, 180
and 1 year after BXMB are shown in Table 1. The change in eGFR [mean (95% CI)] between
initial dose to 14 days was 14.4 (2.5, 26.3), p=0.019; 14 to 90 days was -3.3 (-13.7, 7.0),
p=0.508; and 14 to 180 days was -14.6 (-27.9, -1.2), p=0.034. From the time of initial dose, 1year acute rejection free survival was 66% (95% CI: 46%, 85%) and BOS ≥1 survival was 72%
(95% CI: 53%, 91%).
Conclusion: While improvement in renal function, as measured by change in eGFR was noted
2 weeks following BXMB dose, the resumption of CNI resulted in progressive worsening of renal
function and eGFR returned to pre-intervention levels over 1 year period. We conclude that the
renal preservation effects of BXMB may be transient, thus making it an ineffective therapy when
used for a short duration in lieu of CNI in LTR. Prospective studies evaluating the long term use
of BXMB as an alternative to CNI in patients with poor renal function are warranted.
Table 1: eGFR values at various intervals from the BXMB dose
Time since
BXMB dose
Number of
patients (%)
0 days
7 days
30 days
90 days
180 days
1 year
25 (100)
22 (88)
24 (96)
23 (92)
19 (76)
16 (64)
eGFR
mean±SD
ml/min/1.73m2
39±25.1
62.1±29.5
62.8±44.6
51.7±24.1
36.8±19.2
34.5±15.7