Basiliximab induction alone vs a dual ATG–basiliximab approach in first live-donor non-sensitized kidney transplant recipients with low HLA matching

Background. Individualizing induction therapy based on immunological risk is crucial for optimizing outcomes in kidney transplantation. Methods. A retrospective analysis included 157 first live-donor non-sensitized kidney transplant recipients (KTRs). Within this cohort, 96 individuals exhibited low human leukocyte antigen (HLA) matching (5–6 HLA mismatches). The low HLA match subgroup was categorized into 52 KTRs receiving basiliximab alone and 44 recipients treated with a combined single ATG dose of 1.5 mg/kg and basiliximab. The primary endpoint was early acute cellular rejection (ACR) within 6 months post-transplant while secondary outcomes encompassed infection rates, renal allograft function, length of stay (LOS) and readmissions post-transplant. Results. The incidence of early ACR was decreased for low HLA match KTRs, who received ATG–basiliximab, when compared with low HLA-matched KTRs who received basiliximab alone (9.1% vs 23.9%, P = .067). Age was a predictor for rejection, and subgroup analysis showed consistent rejection reduction across age groups. No significant differences were observed in admission for transplant LOS or in peri-operative complications, nor in infections rate including BK and cytomegalovirus viremia, allograft function and number of readmissions post-transplant up to 6 months post-transplant. Conclusion. In non-sensitized first live-donor KTRs with low HLA matching, a dual ATG–basiliximab induction approach significantly reduced early ACR without compromising safety.