移植技術と研究

Basiliximab in High-risk Group: An African View

Abstract

Jacob Olugbenga Awobusuyi, Julie M Bridson, Ajay Sharma and Ahmed Halawa

In organ transplantation, a wide variety of injurious events such as ischaemia-reperfusion injury, endothelial damage and the traumatic exposure of tissues during surgery occur intra-operatively. The barrage of multiple antigens presented to the recipient cause very intense immunological reaction to occur at the time of transplantation. Thus, an induction immunosuppressive protocol aimed at maximal immunosuppression in the peri-operative period when immunological stimulation is maximal is justified.

Organ transplant recipients of African descent are generally considered as high immunological-risk patients in view of the intense immunological response to transplanted organs seen in these patients compared with their Caucasian counterparts. However, due to the huge additional cost of induction antibody medications, most centers in resource-poor economies in Africa base their induction protocol on high doses of calcineurin based triple-drug therapy. Outcomes from the centers have been considerably poorer in terms of allograft rejection, graft loss and patient survival, compared with other parts of the world where high-risk patients received antibody induction therapy.

Basiliximab induction protocols may offer cost–benefit advantages in resource constrained centers compared with currently used calcineurin based triple-drug therapy. The clinical and financial benefits of reduced acute allograft rejection rates, graft loss and the excellent side effect profile Basiliximab in renal transplant recipients, potentially outweighs the additional costs incurred in the management of higher acute rejection rates, and graft loss in calcineurin based triple-drug therapy.

This reflective review article, examines the possible role of Basiliximab induction protocol as a means of improving clinical outcomes of renal transplantation, in African transplant centres operating in financial constraint economies.