Basiliximab has been associated with a reduced risk of acute cellular rejection, infection and renal failure in liver transplantation. However, its association with early graft dysfunction (EAD) and EAD-related outcomes remains unclear.

A multicenter retrospective cohort was enrolled. Association of basiliximab use with EAD, and EAD-related outcomes (prolonged ICU stay and peri-operative mortality) were evaluated. The treatment effects were estimated using overlap weighting method based on outcome-specific propensity score models incorporating recipient, donor and peri-operative characteristics. Sensitivity analysis was performed after excluding centers with highly imbalanced basiliximab use.

Of 903 eligible recipients, 393 (43.5%) received basiliximab induction. Overlap weighting achieved excellent covariate balance (nearly all absolute standardized mean differences < 0.03). After weighting, EAD incidence was 7.8 percentage points lower with basiliximab (23.3% vs. 31.1%); overlap-weighted logistic regression showed that basiliximab use was associated with significantly lower odds of EAD (OR, 0.67; 95% CI, 0.48–0.94; p = 0.02). No significant associations were observed with prolonged ICU stay or peri-operative mortality, and findings remained robust in sensitivity analyses.

Basiliximab induction was associated with lower odds of EAD after liver transplantation; however, as confounding by indication cannot be excluded in this observational design, validation in larger prospective studies is warranted.