Basiliximab induction in Asian kidney transplant recipients on tacrolimus-based therapy: a SIPTW-adjusted retrospective cohort study

The role of basiliximab induction in Asian kidney transplant recipients receiving tacrolimus-based maintenance immunosuppression remains unclear, particularly among low-risk patients. This single-center retrospective study evaluated 1-year transplant outcomes and infection risk in adult Asian recipients undergoing their first kidney transplantation. We analyzed patients aged over 20 years who underwent kidney transplantation between 2000 and 2021. Patients were categorized into basiliximab induction and no-induction groups; patients at increased immunological risk were recommended to receive self-funded basiliximab induction. The primary outcome was one-year acute rejection; secondary outcomes included one-year graft survival, infection and graft function. Stabilized inverse probability of treatment weighting (SIPTW) was used to balance baseline characteristics, and Cox proportional hazards models and Kaplan–Meier analyses were performed to compare outcomes between the basiliximab and no-induction groups. Among 216 screened recipients, 163 met the inclusion criteria, and 79 (48%) received basiliximab. Within the first year after transplantation, acute rejection occurred in 7 of 79 patients (8.9%) in the basiliximab group and 4 of 84 patients (4.8%) in the no-induction group, with no statistically significant difference in the cumulative incidence of acute rejection at one year (adjusted hazard ratio [aHR], 1.57; 95% confidence interval [CI], 0.52–4.75). One-year graft survival was comparable between groups (aHR, 1.05; 95% CI, 0.96–1.16). One-year estimated glomerular filtration rate (eGFR) was 50.1 ± 24.0 mL/min/1.73 m² in the basiliximab group and 47.9 ± 30.7 mL/min/1.73 m² in the no-induction group, with no statistically significant difference. There was no significant difference in infection risk between the two groups (aHR, 1.41; 95% CI, 0.57–3.48). In this single-center retrospective study of Asian kidney transplant recipients receiving tacrolimus-based maintenance immunosuppression, basiliximab induction showed no significant difference in the short-term outcomes of one-year acute rejection, graft survival, and graft function compared with no induction. A selective, risk-adapted approach, rather than routine induction, may therefore be more appropriate in this setting.