Basiliximab induction shows no short-term benefit in low-risk Asian kidney transplant recipients

Basiliximab induction did not improve one-year outcomes after kidney transplantation in a retrospective cohort of Asian recipients receiving tacrolimus-based maintenance immunosuppression, according to a single-center study published in BMC Nephrology. Among 163 adult first-kidney-transplant recipients analyzed, those who received the interleukin-2 receptor antibody showed no significant advantage in acute rejection, graft survival, graft function, or infection risk compared with patients who received no induction at all.

The study, conducted at a single center, screened 216 recipients who underwent kidney transplantation between 2000 and 2021 and included 163 who met the criteria. Of these, 79 patients, or 48 percent, received basiliximab induction. Patients at increased immunological risk were recommended to receive self-funded basiliximab, while lower-risk patients generally proceeded without induction, creating the comparison the researchers set out to test.

To account for the fact that induction was not assigned randomly, the researchers used stabilized inverse probability of treatment weighting, or SIPTW, to balance baseline characteristics between the two groups. They then applied Cox proportional hazards models and Kaplan–Meier analyses to compare outcomes, with one-year acute rejection as the primary outcome and one-year graft survival, infection, and graft function as secondary outcomes.

Within the first year after transplantation, acute rejection occurred in 7 of 79 patients, or 8.9 percent, in the basiliximab group and 4 of 84 patients, or 4.8 percent, in the no-induction group. After adjustment, the difference was not statistically significant, with an adjusted hazard ratio of 1.57 and a 95 percent confidence interval of 0.52 to 4.75. The wide interval reflects the limited number of rejection events in this cohort.

One-year graft survival was also comparable between the groups, with an adjusted hazard ratio of 1.05 and a 95 percent confidence interval of 0.96 to 1.16. Graft function, measured as estimated glomerular filtration rate at one year, averaged 50.1 plus or minus 24.0 mL/min/1.73 m² in the basiliximab group and 47.9 plus or minus 30.7 mL/min/1.73 m² in the no-induction group, a difference the authors report as not statistically significant.

Infection risk, a key safety concern with any induction agent, did not differ significantly between the groups either, with an adjusted hazard ratio of 1.41 and a 95 percent confidence interval of 0.57 to 3.48. This suggests that, in this population, omitting induction was not associated with an excess of rejection and adding it was not associated with an excess of infectious complications, but also that it provided no measurable short-term benefit.

The authors conclude that in Asian kidney transplant recipients on 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. They suggest that a selective, risk-adapted approach rather than routine induction may be more appropriate in this setting, reserving the agent for patients judged to be at higher immunological risk.

Several limitations deserve emphasis. The study was retrospective and single-center, covering transplants performed over two decades, and induction decisions were made clinically rather than randomly, which is why the investigators applied weighting to balance the groups. All recipients were adults over 20 years of age undergoing their first kidney transplantation at one Asian center, so the findings may not generalize to other populations, retransplant candidates, or centers using different immunosuppressive protocols. The confidence intervals around every estimate were wide, meaning the data cannot rule out modest differences in either direction. As an observational analysis, it can describe associations over one year of follow-up but cannot establish causal effects of induction therapy, and longer-term outcomes beyond the first year were not the focus of this report.

Subject of Research: Basiliximab induction therapy and one-year outcomes in Asian kidney transplant recipients on tacrolimus-based immunosuppression

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

Article References: Fu, C.-J., Chang, W.-C., & Wang, L.-Y. (2026). Basiliximab induction in Asian kidney transplant recipients on tacrolimus-based therapy: a SIPTW-adjusted retrospective cohort study. BMC Nephrology. https://doi.org/10.1186/s12882-026-05453-4

Image Credits: AI Generated

DOI: 10.1186/s12882-026-05453-4

Keywords: kidney transplantation, basiliximab, induction therapy, tacrolimus, acute rejection, graft survival, SIPTW, retrospective cohort study, immunosuppression, transplant outcomes, infection risk, nephrology