Background Up until 2014, basiliximab was used in our hospital as an off-label prescription for hepatic transplantation in patients for whom starting tacrolimus had to be delayed because of their baseline characteristics. Dosage is two 20 mg perfusions (days 0 and +4 after transplantation). The second dose could be skipped if the patient has stable renal function. From 2014 onwards, all patients undergoing transplantation received the first dose in order to delay beginning tacrolimus and to reduce morbidity and hospitalisation time.
Purpose Clinical and economic assessment after the protocol change.
Material and methods Retrospective analysis of liver transplanted patients in 2013 vs. 2014 (new protocol), registering: age, sex, diagnosis, creatinine on ICU and hospital discharge, ICU stay, global stay, number of basiliximab doses administered, day beginning tacrolimus treatment after transplantation, and global and per patient economic cost.
ResultsBeginning tacrolimus was always day +1 when basiliximab was not administered and day +5 when two doses were administered. For patients receiving only one dose, in 2013 it was day +4.5 and in 2014 it was day +3.1. Creatinine on ICU discharge was significantly higher (1.11 vs 0.82, p < 0.05) in 2014, with no significant differences found for creatinine prior to transplantation, on hospital discharge or global or ICU stay. Vial consumption was 0.75/patient in 2013 and 1.5/patient in 2014, with a global cost difference of 31 301.37€.
Conclusion In our population, the protocol change did not show any clinical benefits in the parameters assessed (creatinine and ICU/hospital stay). Preliminary estimation of 50% of patients not receiving the second dose after the protocol change was fulfilled.
References and/or Acknowledgements
Neuberger, et al. Delayed introduction of reduced-dose tacrolimus, and renal function in liver transplantation: the ‘ReSpECT’ study. Am J Transplant 2009.
References and/or AcknowledgementsNo conflict of interest.
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