Minimization of immunosuppression with thymoglobuline pre-treatment and HCV recurrence in liver transplantation.
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.
De Ruvo
Nicola
N
Liver and Multiorgan Transplant Center, University of Bologna, Bologna, Italy.
Cucchetti
Alessandro
A
Lauro
Augusto
A
Masetti
Michele
M
Di Benedetto
Fabrizio
F
Cautero
Nicola
N
La Barba
Giuliano
G
Dazzi
Alessandro
A
Di Francesco
Fabrizio
F
Molteni
Gabriele
G
Romano
Antonio
A
Ramacciato
Giovanni
G
Risaliti
Andrea
A
Pinna
Antonio Daniele
AD
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
D000961:Antilymphocyte Serum; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D016559:Tacrolimus; D008775:Methylprednisolone