Induction immunosuppression with rabbit antithymocyte globulin in pediatric liver transplantation.
Routine use of rabbit antithymocyte globulin (RATG) induction therapy remains controversial in pediatric liver transplantation. We reviewed our experience of 18 cadaveric liver transplants in 18 children over a span of 2 years. All patients received the same immunosuppression: perioperative steroid therapy with taper, 3 doses of RATG, and maintenance therapy of steroids and tacrolimus started on postoperative day 3. Mean follow-up was 2.2 +/- 0.2 years. End-stage liver disease was secondary to biliary atresia in 10 patients (56%) and metabolic disorders in 4 patients (22%). Graft and patient survival were 89%. Serum bilirubin was 1.2 mg/dL, 1.1 mg/dL, 0.5 mg/dL, and 0.5 mg/dL at 1, 3, 6, and 12 months, respectively. The 2 mortalities were secondary to multiple organ system failure. Overall rejection rate was 17% (3/18). Rejection episodes occurred at 4, 6, and 7 months. Two patients were treated with steroids; the third was treated with OKT3. No patient has developed posttransplant lymphoproliferative disease. Serum creatinine was 0.7 mg/dL, 0.6 mg/dL, 0.6 mg/dL, and 0.6 mg/dL at 1, 3, 6, and 12 months, respectively, among surviving patients. In conclusion, our data suggest that RATG induction with steroid and tacrolimus maintenance therapy is safe, easy to use, and effective in the prevention of rejection.
Shah
Ashesh
A
Surgery, Indiana University, Indianapolis, IN, USA.
Agarwal
Avinash
A
Mangus
Richard
R
Lim
Joel
J
Fridell
Jonathan
J
Vianna
Rodrigo
R
Tector
A Joseph
AJ
D000818:Animals; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D018890:Chemoprevention; D002648:Child; D003404:Creatinine / Q000097:blood; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation; D011817:Rabbits; D012189:Retrospective Studies; D015996:Survival Rate
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D003404:Creatinine