Purpose: A shortage of organ donors in Japan has delayed the waiting period for heart transplant (HTX) by up to 4 years, even in Status 1 patients. More than ninety percent of patients are waiting for HTX under ventricular assist device. During this period, most patients are experienced various complications, such as infection, cerebral infarction, and renal dysfunction. Basiliximab, a mouse-human chimeric antibody to the IL-2 receptor of human T-cells, is an immunosuppressive drug that inhibits T-cell activation. It is theoretically able to delay the use of calcineurin inhibitors (CNIs) and is expected to be used as induction therapy to avoid postoperative CNI-induced renal dysfunction.
Methods: In our hospital, we began administering basiliximab after 2015 to patients at risk of post-HTX renal dysfunction when the waiting period for HTX exceeded 1,000 days.  
Results: Before 2015, the waiting period for HTX was 521 to 1,253 (855 ± 240) days in 15 patients (Group A), and 1,040 to 2,187 (1,385 ± 340) days in 15 patients (group B). The serum creatinine level in individuals before transplantation was 0.58 to 2.52 (1.21 ± 0.47) mg/dL in group A, compared to 0.61 to 2.08 (1.29 ± 0.48) mg/dL in 11 patients who received basiliximab in group B. IL-2 receptor of lymphocytes was quickly suppressed < 5% and lasted for one month in the patients receiving basiliximab in group B (Figure). Although the start of tacrolimus was significant late among patients receiving basiliximab (4.6 ± 1.4 vs 2 ± 0.8 day, p = 0.003), all patients didn’t experience rejection in the acute phase. Furthermore, all patients didn’t experience post-HTX renal dysfunction or basiliximab side effects.
Conclusions: Given the remarkably long waiting period for HTX in Japan, it is important to avoid worsened renal function after transplantation. There is hope that basiliximab as induction therapy can be beneficial in this regard.