Routine induction therapy in living donor liver transplantation prevents rejection but may promote recurrence of hepatitis C.
BACKGROUND
Routine induction therapy in living donor liver transplantation (LDLT) has not been well described.


METHODS
We reviewed outcomes of induction therapy with rabbit antithymocyte globulin (rATG) or basiliximab within 1 year of LDLT.


RESULTS
Between 2002 and 2007, 184 adults underwent LDLT and received induction therapy in addition to standard immunosuppression. Acute cellular rejection (ACR) developed in 17 of 130 patients (13.1%) who received rATG and 13 of 54 patients (24.1%) who received basiliximab (P = .066). The interval between transplantation and rejection as well as rejection severity was similar in patients who received rATG and those who received basiliximab. Hepatitis C (HCV) recurrence requiring initiation of antiviral therapy was more common in patients who received rATG compared with basiliximab (34.5% vs 8.7%; P = .021), and in those who received induction combined with tacrolimus as opposed to cyclosporine (38.5% vs 3.9%; P = .001). rATG and basiliximab were associated with excellent patient and graft survivals well as low rates of opportunistic infections and malignancies.


CONCLUSIONS
Induction with rATG or basiliximab was well tolerated and highly effective at preventing ACR within 1 year of LDLT, but may be associated with a higher risk of clinically significant HCV recurrence in some patients.
University of Toronto Liver Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada. anand.ghanekar@uhn.ca
A
A
Ghanekar
A
A
Kashfi
M
M
Cattral
N
N
Selzner
I
I
McGilvray
M
M
Selzner
E
E
Renner
L
L
Lilly
G
G
Levy
D
D
Grant
P
P
Greig
D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000961:Antilymphocyte Serum / Q000009:adverse effects*; D000998:Antiviral Agents / Q000627:therapeutic use; D000077552:Basiliximab; D016009:Chi-Square Distribution; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008103:Liver Cirrhosis / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011993:Recombinant Fusion Proteins / Q000009:adverse effects*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D019172:Transplantation Conditioning / Q000009:adverse effects*; D016896:Treatment Outcome; D014775:Virus Activation
D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab