Basiliximab induction reduces the incidence of acute rejection in lung transplant patients

Introduction: Lung transplantation (LTx) is a therapeutic option for patients with end-stage lung disease. Induction immunosuppression has been shown to reduce acute rejection in LTx. The major potential complication is an increased risk of infection. Objectives: The aim of this retrospective study is to compare acute rejection with or without induction strategy in the first month after LTx. Methods: A retrospective review was done of all patients who underwent LTx from January 1, 2014 to December 31, 2017. Before April 1, 2016 Basiliximab was used in selected patients. From April 1, 2016 we use induction therapy in all patients per protocol. In the third week after transplant a bronchoscopy is performed per protocol with transbronchial biopsies and bronchoalveolar lavage (BAL). We compare the incidence of acute rejection in the first month after LTx, and positive BAL for any bacteria. Results: 165 patients were included. 65.5% male. 66.1% bilateral LTx. Mean age: 55.01 ± 10.81 years. 50.9% received induction with Basiliximab. In the third week after the LTx, 49% of them had acute rejection (A0: 50.3%; A1: 8.8%; A2: 32%. A3: 8.8%). 35.1% of BAL´s were positive for any bacteria. The group with Basiliximab had lower incidence of acute rejection (p = 0.009). No differences were found in positive BAL´s cultures (p=0.472). No significant differences were found in the mechanical ventilation time (p=0.052), ICU stay (p=0.303). The induction group had lower length of hospital stay (p=0.002). Conclusions: The use of induction therapy with Basiliximab in LTx patients reduces the incidence of acute rejection in the first month after transplant, with no differences in positive BAL cultures.