Promising early results with immunosuppression using rabbit anti-thymocyte globulin and steroids with delayed introduction of tacrolimus in adult liver transplant recipients.
Induction therapy with T-cell depleting drugs in liver transplantation is controversial. This study examined the use of rabbit antithymocyte globulin (RATG) with delayed introduction of tacrolimus in liver transplant recipients. Additional subgroup analysis compared patients with or without hepatitis C (HCV) cirrhosis. Over 17 months, 116 adults received 120 liver allografts. Four patients who died before receiving RATG were excluded. Immunosuppression included steroids, 3 doses of RATG (2 mg/kg), and tacrolimus started on postoperative day 3 to 4. Ninety-six percent of patients were alive with a mean follow-up of 12.9+/-4.5 months. No graft was lost to rejection. Two patients developed hepatic artery thrombosis. Six percent of patients had acute rejection. No patient had steroid resistant or recurrent rejection. RATG related drug events were limited to fever, chills, tachycardia, and oxygen desaturation. There were no cases of lymphoproliferative disease. Forty-two percent of patients were transplanted for HCV. Thirty-two percent of HCV-patients had biopsy proven hepatitis C recurrence occurring at 4 weeks to 10 months posttransplant. RATG induction therapy is associated with good patient and graft survival, a low incidence of rejection, and minimal side effects. In addition, RATG induction is safe in patients transplanted for HCV.
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA. atector@iupui.edu
A Joseph
AJ
Tector
Jonathan A
JA
Fridell
Richard S
RS
Mangus
Ashesh
A
Shah
Martin
M
Milgrom
Paul
P
Kwo
Naga
N
Chalasani
Hwan
H
Yoo
Dale
D
Rouch
Suthat
S
Liangpunsakul
Scott
S
Herring
Lawrence
L
Lumeng
D000328:Adult; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006526:Hepatitis C / Q000150:complications / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008103:Liver Cirrhosis / Q000276:immunology / Q000601:surgery / Q000821:virology; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods; D008775:Methylprednisolone / Q000008:administration & dosage*; D016019:Survival Analysis; D016559:Tacrolimus / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016559:Tacrolimus; D008775:Methylprednisolone