ORIGINAL RESEARCH
Transpl. Int.
Impact of Induction Therapy in Low Immunological Risk Simultaneous Pancreas-Kidney Transplantation
- EM
Enrique Montagud-Marrahi 1
- AR
Adriana Rodriguez-Gonzalo 2
- JV
Joan Vidiella 3
- BM
Blanca Martin Álvarez 4
- IG
Irving Gaston Ramírez 5
- AB
Albert Baronet 6
- JF
Joana Ferrer-Fàbrega 6
- AJ
Antonio J. Amor 6
- MJ
Maria Jose Ramirez-Bajo 2
- MM
Mireia Musquera 6
- FD
Fritz Diekmann 6
- PV
Pedro Ventura-Aguiar 6
1. Instituto Clínic de Nefrología y Urología, Hospital Clinic of Barcelona, Barcelona, Spain
2. Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
3. Consorcio Corporacion Sanitaria Parc Tauli, Sabadell, Spain
4. Hospital Universitario Rio Hortega, Valladolid, Spain
5. Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico
6. Hospital Clinic de Barcelona, Barcelona, Spain
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Abstract
T-cell depleting agents and IL-2 receptor blockers are the most common induction therapies in simultaneous pancreas-kidney transplantation (SPKT),but the optimal choice remains debated.Here, we perform a retrospective,single-center study with SPKT recipients from 2000 to 2023. Basiliximab was used between 2008 and 2013, and thymoglobulin in other periods.Patients with prior transplants, calculated PRA>20%, pre-SPKT Donor-Specific Antibodies or graft primary non-function because technical reasons, were excluded.An Inverse Probability of Treatment Weighting(IPTW) was performed to adjust for confounding variables. 305 SPKT recipients were included,of which 172(56%) received thymoglobulin and 133(44%) basiliximab.Recipient (86%vs80%), pancreas (86%vs83%) and kidney (84%vs89%) death-censored graft survival at 20 years were comparable between groups. Basiliximab was not associated with an increased risk of patient death (HR 1.47[0.69–3.14], P=0.32),pancreas (HR 1.08[0.55–2.10],P=0.83) or kidney graft failure(HR 0.80[0.38–1.70],P=0.56) compared to thymoglobulin. Basiliximab did not significantly increase the risk of pancreas (OR 1.49[0.84–2.63],P=0.37) or kidney graft rejection (OR 1.31[0.54–3.15],P=0.20).However, it was associated with significantly lower risk of CMV (OR 0.41[0.23–0.72],P=0.002) and BK virus infections (OR 0.31[0.12–0.80],P=0.02).No significant difference was found in new-onset malignancy incidence.These results were maintained even after IPTW adjustment. In SPKT recipients with low immunological risk,basiliximab provides comparable long-term patient and graft outcomes to thymoglobulin while reducing the incidence of opportunistic infections.
Summary
Keywords
simultaneous kidney pancreas transplantation, Thymoglobulin, Basiliximab, Opportunistic infections, neoplasm
Received
13 July 2025
Accepted
22 September 2025
Copyright
© 2025 Montagud-Marrahi, Rodriguez-Gonzalo, Vidiella, Martin Álvarez, Gaston Ramírez, Baronet, Ferrer-Fàbrega, Amor, Ramirez-Bajo, Musquera, Diekmann and Ventura-Aguiar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Pedro Ventura-Aguiar, pventura@clinic.cat
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