Evaluating the efficacy of basiliximab versus no induction in low-immunological-risk kidney transplant recipients: a propensity score matched analysis

The optimal use of induction therapy in low-immunological-risk kidney transplant recipients (KTRs) remains uncertain. While Basiliximab (BSX) is widely utilized, its comparative outcomes with no induction therapy require further evaluation. This single-center retrospective cohort study included 182 low-immunological-risk KTRs who underwent transplantation between January 2022 and March 2023. Patients were assigned to either no induction (<i>n</i> = 41) or BSX induction (<i>n</i> = 141) groups. Propensity score matching (PSM) minimized selection bias and controlled for confounding factors. Primary outcomes included the incidence of first acute rejection (AR) within 12 months, while secondary outcomes encompassed graft function, infection rates, and adverse events. After 12 months, the cumulative AR incidence was comparable between groups (<i>p</i> = 0.46). The no induction group demonstrated superior renal function, with consistently higher estimated glomerular filtration rates (eGFR) at early postoperative intervals. Additionally, this group exhibited reduced infection-related hospitalizations (respiratory infections: 7.32 vs. 29.1%, <i>p</i> = 0.008) and hematological complications (thrombocytopenia: 0.00% vs. 12.8%, <i>p</i> = 0.014). Mortality and graft loss rates were similar between groups. In low-immunological-risk KTRs, no induction therapy achieves comparable AR prevention and renal function outcomes to BSX while reducing infection and hematological complications. These findings challenge the necessity of universal induction therapy in this population and support a personalized approach to immunosuppression protocols.

低免疫风险肾移植受者（kidney transplant recipients, KTRs）诱导治疗的最优方案仍不明确。尽管巴利昔单抗（Basiliximab, BSX）应用广泛，但其与无诱导治疗的对比疗效仍需进一步评估。本项单中心回顾性队列研究纳入了2022年1月至2023年3月期间接受肾移植的182例低免疫风险肾移植受者，将患者分为无诱导治疗组（n=41）与巴利昔单抗诱导治疗组（n=141）。通过倾向得分匹配（Propensity score matching, PSM）最小化选择偏倚并控制混杂因素。主要结局指标为术后12个月内首次急性排斥反应（acute rejection, AR）的发生率；次要结局指标包括移植肾功能、感染发生率及不良事件。随访12个月后，两组的累积急性排斥反应发生率无显著差异（p=0.46）。无诱导治疗组的肾功能更优，术后早期估算肾小球滤过率（estimated glomerular filtration rates, eGFR）持续更高。此外，该组的感染相关住院率更低：呼吸道感染发生率为7.32% vs. 29.1%（p=0.008），血液系统并发症发生率亦更低（血小板减少症：0.00% vs. 12.8%，p=0.014）。两组的死亡率及移植肾失功率无显著差异。对于低免疫风险肾移植受者，无诱导治疗在预防急性排斥反应与维持肾功能方面的效果与巴利昔单抗诱导治疗相当，同时可降低感染与血液系统并发症的发生风险。本研究结果对该人群需常规实施诱导治疗的必要性提出了挑战，并支持免疫抑制方案的个体化制定。