2026 Eastern States Conference

Title: Impact of induction immunosuppression on renal function in liver transplant
Authors: Savannah Savage, PharmD; Claire Lin, PharmD; Jennifer Geyston, PharmD, BCPS, BCTXP; University of Virginia Health, Charlottesville, VA
Learning objective: Compare the effects of methylprednisolone (MP) versus basiliximab induction immunosuppression on renal function in liver transplant (LT) recipients.
Background/Objective: Renal dysfunction after LT worsens outcomes. Basiliximab is used post-LT to delay initiation of tacrolimus to prevent postoperative nephrotoxicity and promote renal recovery, but benefit is unclear. A shortage allowed comparison with MP induction.
Methods: This single-center, retrospective, cohort study evaluated adult LT recipients who received either MP only or basiliximab induction at the University of Virginia Health between January 1, 2024, to April 6, 2025. Exclusions included patients with previous transplant or retransplantation during index hospitalization, multi-organ transplant, and death during index stay. Primary outcome was renal function at post-operative day (POD) 30. Secondary outcomes included time to initiation tacrolimus, time to target tacrolimus level, serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) at POD 1, POD 7, and 3-, 6- and 12-months, biopsy-proven acute rejection (BPAR), graft failure and mortality. Patients were followed for 12-months post-LT. Data was obtained through manual chart review. Categorical variables analyzed with chi-squared or Fisher’s exact tests; continuous variables using Mann-Whitney U test. Significance defined as p<0.05.
Results: A total of 56 patients were included in the final analysis, with 12 receiving MP and 44 receiving basiliximab. Majority of patients were white males with alcoholic liver disease. Baseline median eGFR was similar (MP 70.2 vs basiliximab 69.7 mL/min/1.73m2, p=0.59). At POD 30, there was no significant difference in median eGFR between groups (MP 58.9 vs basiliximab 66.2 mL/min/1.73m2, p=0.31). Time to tacrolimus initiation was statistically different between groups (median time: MP 3 vs basiliximab 4 days, p=0.02). No significant differences were observed in SCr or eGFR at time points evaluated or time to tacrolimus goal level. No BPAR or graft failure was observed in this patient population, and mortality was similar between groups.
Conclusion: Patients who received MP-only induction had renal outcomes comparable to those who received basiliximab. Tacrolimus was started earlier in the MP group, but this did not result in reaching target tacrolimus levels any sooner. These findings support consideration of steroid-only induction as a reasonable alternative without increasing the risk of acute rejection or graft failure.
Self-Assessment Question: True/False: In our cohort, steroid-only induction showed significantly worse renal outcomes compared to basiliximab and should not be considered for induction therapy.