Optimizing use of basiliximab in liver transplantation

Antibody induction therapy has not been part of standard immunosuppressive regimens in liver transplantation. However, in recent years there has been an upward trend in the use of antibody induction therapy in orthotopic liver transplantation (OLT), attributed mainly to the growing number of OLT recipients with renal dysfunction after the Model for End Stage Liver Disease (MELD) scoring system was adopted in 2002. Basiliximab, a chimeric monoclonal antibody, is the most frequently used induction antibody in OLT. Basiliximab targets the alpha chain of interleukin-2 receptors in activated T-lymphocytes, inhibiting T-lymphocyte proliferation responsible for acute cellular rejection. Basiliximab (given in two 20 mg doses intravenously on post OLT day 0 and 4) has an excellent efficacy and safety profile. Basiliximab induction also allows early steroid withdrawal or avoidance, as well as delayed introduction and minimization of calcineurin inhibitors (CNI) in the setting of renal insufficiency. Although its long-term effect on hepatitis C virus (HCV) recurrence post OLT is currently unknown, studies using basiliximab induction in steroid-free protocols suggest no harmful effect on histologic HCV recurrence and survival rates. Basiliximab is a well tolerated, effective and safe anti-rejection drug in pediatric and adult OLT recipients when given in conjunction with a CNI-based immunotherapy.