title: Minimization of immunosuppression with thymoglobuline pre-treatment and HCV recurrence in liver transplantation.
abstract: Induction with thymoglobuline, a potent anti-thymocyte polyclonal antibody, has been recently reported to allow minimization of postoperative immunosuppression in organ transplantation. The relationship with recurrence of hepatitis C virus (HCV) after liver transplantation (LTx) has never been investigated. We report here on the outcome in 22 HCV+ patients receiving thymoglobuline pre-treatment and minimal immunosuppression after LTx. Patient survival and acute rejection rates were good, and remarkably low dosages and levels of immunosuppression were achieved with thymoglobuline, without exposing patients to an elevated risk of rejection. A progressive weaning of the primary immunosuppressor was also possible in the majority of patients without complications. The HCV recurrence rate was similar to what is reported in the literature, although lower HCV-RNA viral loads were obtained with thymoglobuline, with a mild histologic course. Although our results need to be validated in large cohort studies, our experience shows that minimization of immunosuppression with thymoglobuline is effective in protecting against rejection and demonstrated a positive impact on HCV recurrence that deserves further investigation.
authors.affiliation: Liver and Multiorgan Transplant Center, University of Bologna, Bologna, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: De Ruvo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Augusto
authors.initials: A
authors.lastname: Lauro
authors.forename: Michele
authors.initials: M
authors.lastname: Masetti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Benedetto
authors.forename: Nicola
authors.initials: N
authors.lastname: Cautero
authors.forename: Giuliano
authors.initials: G
authors.lastname: La Barba
authors.forename: Alessandro
authors.initials: A
authors.lastname: Dazzi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Francesco
authors.forename: Gabriele
authors.initials: G
authors.lastname: Molteni
authors.forename: Antonio
authors.initials: A
authors.lastname: Romano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
authors.forename: Andrea
authors.initials: A
authors.lastname: Risaliti
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D004279:DNA, Viral / Q000032:analysis; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D012008:Recurrence; D015996:Survival Rate; D013601:T-Lymphocytes / Q000276:immunology*; D016559:Tacrolimus / Q000627:therapeutic use; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000961:Antilymphocyte Serum; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D016559:Tacrolimus; D008775:Methylprednisolone