title: Thymoglobulin induction protects liver allografts from ischemia/reperfusion injury.
abstract: BACKGROUND
  Interventions that minimize hepatic ischemia/reperfusion injury (IRI) can expand the donor organ pool. Thymoglobulin (TG) induction therapy has been shown to ameliorate delayed graft function and possibly decrease IRI in cadaver renal transplants recipients. This controlled randomized trial was designated to assess the ability of TG to protect against IRI in liver transplant recipients.
  
  
  METHODS
  Twenty-two cadaveric liver transplant recipients were randomized to receive either TG (1.5 mg/kg/dose) during the anhepatic period and QOD x2 doses or no TG. No differences in recipients' demographics were present and donor characteristics were similar in terms of age, cause of death, and cold ischemia time. Maintenance immunosupression consisted of Tacrolimus (or Cyclosporine) and steroids for both groups. Donor biopsies were obtained during organ procurement, cold storage and 1 h after re-vascularization. Post-operative liver function tests were monitored. Early graft function, length of stay, patient and graft survival rates, incidence of primary non-function and rate of rejection were assessed.
  
  
  RESULTS
  Patient and graft survival at 3 months was 100%. There was no incidence of primary graft non-function and no need for re-transplantation. The incidence of acute rejection was similar between the two groups. Patients in the TG group had significant decreases in alanine aminotransferase test at day 1 compared to the control group (p = 0.02). There were also near significant decreases of total bilirubin at day 5 and shorter length of hospitalization. Liver biopsy (at procurement, when cold, and post-reperfusion) of TG group demonstrated a trend for increased central ballooning.
  
  
  CONCLUSIONS
  The TG allowed for more compromised liver grafts to be transplanted with less clinical evidence of IRI and improved function. Further studies on the degree of apoptosis in the liver biopsy post-reperfusion are underway.
authors: Division of Transplantation, Department of Surgery, University of Illinois Medical Center at Chicago, Chicago, IL 60612, USA.
authors: Diego
authors: D
authors: Bogetti
authors: Howard N
authors: HN
authors: Sankary
authors: Tomasz M
authors: TM
authors: Jarzembowski
authors: Antonio
authors: A
authors: Manzelli
authors: Peter S
authors: PS
authors: Knight
authors: James
authors: J
authors: Thielke
authors: Gregorio
authors: G
authors: Chejfec
authors: Scott
authors: S
authors: Cotler
authors: Jose
authors: J
authors: Oberholzer
authors: Giuliano
authors: G
authors: Testa
authors: Enrico
authors: E
authors: Benedetti
mesh_terms: D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000502:physiology*; D001663:Bilirubin / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007902:Length of Stay; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015427:Reperfusion Injury / Q000517:prevention & control*; D015996:Survival Rate; D016559:Tacrolimus / Q000008:administration & dosage; D000637:Transaminases / Q000097:blood; D014184:Transplantation, Homologous
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D000637:Transaminases; D001663:Bilirubin; D016559:Tacrolimus