Delayed tacrolimus dose reduction plus basiliximab yields better kidney function after liver transplant

A delayed dose reduction of tacrolimus, along with induction of basiliximab, helps suppress kidney injury in liver transplant recipients, as opposed to standard-dose tacrolimus, a recent study has found. Such benefits come with no excess risk of rejection, graft loss, or death.

Researchers conducted a retrospective cohort study of patients who had undergone liver transplantation between 2000 and 2017. Participants were divided into two: those who had received conventional treatment (immediate dose reduction of tacrolimus with corticosteroids; n=203) and the revised treatment (basiliximab with delayed tacrolimus dose reduction; n=343).

Kidney function, the primary outcome, was assessed according to measured estimated glomerular filtration rate (mGFR). At baseline, before transplantation, mean mGFR was comparable between the conventional and revised treatment groups (85.3 vs 84.1 mL/min/1.73 m², respectively; p=0.60).

However, as early as 3 months after the procedure, patients who received the revised treatment regimen showed significantly higher mGFR than their conventionally treated comparators (63.4 vs 56.8 mL/min/1.73 m²; p=0.004). Such a difference persisted until 12 months after the operation (69.7 vs 60.9 mL/min/1.73 m²; p<0.001).

Conversely, the absolute declines in mean mGFR from baseline were significantly lower in the revised-treatment group both at 3 months (p=0.005) and 12 months (p<0.001).

In terms of safety, the researchers demonstrated comparable patient survival between groups (p=0.16), with slightly but significantly superior graft survival rates in the revised-treatment group at 5 years post-transplantation (p=0.01). Biopsy-proven acute rejection likewise occurred less frequently in those who received the revised treatment at 3-, 6-, and 12-months postoperation (p<0.001 for all).