Thymoglobulin induction protects liver allografts from ischemia/reperfusion injury.
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.
Bogetti
Diego
D
Division of Transplantation, Department of Surgery, University of Illinois Medical Center at Chicago, Chicago, IL 60612, USA.
Sankary
Howard N
HN
Jarzembowski
Tomasz M
TM
Manzelli
Antonio
A
Knight
Peter S
PS
Thielke
James
J
Chejfec
Gregorio
G
Cotler
Scott
S
Oberholzer
Jose
J
Testa
Giuliano
G
Benedetti
Enrico
E
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
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D000637:Transaminases; D001663:Bilirubin; D016559:Tacrolimus