Background: Induction with the use of interleukin-2 receptor chimeric monoclonal antibodies can significantly influence rejection-free survival in orthotopic liver transplant (LT) recipients, inhibiting T-lymphocyte proliferation responsible for acute cellular rejection. On the contrary, the benefit of Basiliximab induction therapy are not clear after liver retransplantation (re-LT), a procedure associated with poorer outcome compared to the primary LT. The aim of this study was to analyze a single center’s experience with Basiliximab use in re-LT for patients with poor graft function after primary LT.
Methods: This is a retrospective analysis of indications, timing, surgical techniques and outcomes of two groups of consecutive re-LT patients after primary LT between 1999 and 2017 in our centre, different for Basiliximab induction avoidance in immunosuppressive regimen.
Results: Of the 915 primary LTs in adult recipients, 55 (6%) patients required a first re-LT, none of them underwent a second re-LT. Hepatitis C-related liver cirrhosis (23 patients, 41.8%) was the most common diagnosis for the primary LT, complicated by hepatocellular carcinoma (HCC) in 9 cases, and followed by hepatitis B-related cirrhosis (10 patients, 18.1%). Majority of re-LTs were performed within 6 months (45 patients, 81.8%), early (20 patients, 36.3%, day 0 – 7; 17 patients, 30.9%, day 8 – 30) and intermediately (7 patients, 12.7%, 1 – 6 months), of primary LT. Major indications for the first re-LT were: primary graft non-function (19 patients, 34.5%), hepatic artery thrombosis (15 patients, 27.2%), delayed graft function (8 patients, 14.5%)  and recurrent Hepatitis C-related liver diseases (12.7%). All re-LT patients underwent classic LT technique with cadaveric allografts. Patient death occurred in 29 cases (52.7%). Sepsis related multiple-organ failure was the most common cause of death in 51.7% of cases after re-LTs.
There were 38 patients in Group A (Basiliximab free) (69.9%), and 17 patients in Group B (Basiliximab on board) (30.1%). The entire study population were treated with a tacrolimus-based immunosuppressive protocol. The 17 consecutive patients of Group B received induction of the immunosuppressive regimen with Basiliximab 20 mg, which was administered by i.v. bolus in both groups, during anhepatic phase and on postoperative day 4 after LT.  The 1- and 5-year patient survival rates after re-LTs were 78.9%, 72.8%, and 41.2%, 34.3%, in the Group A and B, respectively. Survival of Group B patients was significantly poorer than of those who underwent re-LT without Basiliximab induction (p < 0.001).
Conclusion: Although it is necessary to validate with larger series the results of this analysis, our experience suggests the use of Basiliximab induction in very sick patient is associated with higher morbidity identified by the patient death after re-LT.