Basiliximab induction versus no induction in adult heart transplantation.

Induction immunosuppression in heart transplant recipients varies greatly by center. Basiliximab (BAS) is the most commonly used induction immunosuppressant but has not been shown to reduce rejection or improve survival. The objective of this retrospective study was to compare rejection, infection, and mortality within the first 12 months following heart transplant in patients who received BAS or no induction. This was a retrospective cohort study of adult heart transplant recipients given BAS or no induction from 1/1/2017 to 5/31/2021. The primary endpoint was incidence of treated acute cellular rejection (ACR) at 12- months post-transplant. Secondary endpoints included ACR at 90 days post-transplant, incidence of antibody-mediated rejection (AMR) at 90 days and one year, incidence of infection, and all-cause mortality at 1 year. 108 patients received BAS, and 26 patients received no induction within the specified timeframe. There was a lower incidence of ACR within the first year in the BAS group compared to the no induction group (27.7 vs 68.2%, p < 0.002). BAS was independently associated with a lower probability of having a rejection event during the first 12- months post-transplant (HR 0.285, 95% CI 0.142-0.571, p < 0.001). There was no difference in the rate of infection and in mortality after hospital discharge at one-year post-transplant (6 vs 0%, p = 0.20). BAS appears to be associated with greater freedom from rejection without an increase in infections. BAS may be a preferred to a no induction strategy in patients undergoing heart transplantation. This article is protected by copyright. All rights reserved.