Efficacy and safety of induction therapy with rabbit antithymocyte globulins in liver transplantation for hepatitis C.
BACKGROUND
Hepatitis C virus (HCV)-related end-stage liver disease (ESLD) is the leading cause for orthotopic liver transplantation (OLT). However, in recent years, the long-term results of OLT in this setting are worsening, possibly due to the powerful immunosuppressants in use. The aim of our study was to assess the safety and efficacy of induction therapy using rabbit antithymocyte globulin antibodies (RATG).


METHODS
Over an 18-month period from January 2000 to June 2001, 16 patients underwent OLT for HCV-related ESLD and survived more than 1 month posttransplantation. They received induction therapy based on RATG (Thymoglobulins, Sangstat, France) at 1 mg/kg per day for 3 consecutive days, and it was then adjusted to maintain a CD2 count below 50/mm(3). Overall, RATG was given for a median of 5 days for a total dose of 406 +/- 45 mg. Steroids were started pretransplant and tacrolimus on day 1. The primary end-points were patient and graft survivals at 6 months posttransplantation, incidence of rejection, infectious complications (bacterial, viral, and fungal) and recurrence of HCV infection based on biochemical, virological, and histologic criteria.


RESULTS
The survival rates were 100% for patients and 93.7% for grafts. The acute rejection rate was 37.5%. The median time to acute rejection was 15.5 days. There was only one serum sickness case. Cytomegalovirus infections occurred in 25% of patients. The rate of de novo diabetes that required insulin therapy was at 50%. The rate of HCV recurrence was 56.25%. In addition, HCV RNA serum concentrations increased significantly posttransplantation (>1 log). In conclusion, RATG induction therapy is safe and efficient in HCV-positive liver recipients.
Kamar
N
N
Department of Nephrology, Dialysis and Multiorgan Transplantation, CHU Toulouse-Rangueil, 31059 Toulouse Cedex 9, France.
Ribes
D
D
Sandres-Saune
K
K
Suc
B
B
Barange
K
K
Cointault
O
O
Lavayssiere
L
L
Durand
D
D
Izopet
J
J
Rostaing
L
L
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000097:blood; D005260:Female; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007958:Leukocyte Count; D017093:Liver Failure / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000276:immunology* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011817:Rabbits; D012189:Retrospective Studies; D012449:Safety; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D016559:Tacrolimus