title: Impact of anti-thymocyte globulin during immunosuppression induction in patients with hepatitis C after liver transplantation.
abstract: BACKGROUND
  Induction immunosuppression with anti-thymocyte globulin (ATG) provides potential benefits after liver transplantation (LT). However, its use in patients with LT and hepatitis C (HCV) is controversial.
  
  
  OBJECTIVE
  To evaluate the 1- and 2-year patient survival and HCV recurrence rate in patients receiving ATG during the induction phase of immunosuppression (IPI) after LT.
  
  
  METHODS
  A total of 49 patients undergoing their first LT for HCV were randomized to receive ATG during IPI. Patient survival and HCV recurrence were determined at 1 and 2 years. The frequency of acute cellular rejection (ACR), infections, and neoplasms was also evaluated.
  
  
  RESULTS
  Twenty-six patients were randomized to receive ATG (Arm-1) and 23 to standard induction therapy (Arm-2). Those given ATG had lower HCV recurrence (26.9 vs 73.9 %, p = 0.001). The 1- and 2-year patient survival rates were similar for both arms (p = 0.33). Infections occurred in 46.1 % subjects in Arm-1 and 34.7 % in Arm-2 (p = 0.562). There was a greater proportion of fungal infections in Arm-1 (19.2 vs 0 %, p = 0.032).
  
  
  CONCLUSIONS
  ATG during the IPI was associated with lower frequency of recurrence of HCV in patients undergoing LT. This, however, did not affect the 1- and 2-year survival and the frequency of ACR, infections, or neoplasms.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St #567, Little Rock, AR, 72205, USA, MGarcia@uams.edu.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Garcia-Saenz-de-Sicilia
authors.forename: Marco A
authors.initials: MA
authors.lastname: Olivera-Martinez
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Grant
authors.forename: David F
authors.initials: DF
authors.lastname: Mercer
authors.forename: Chen
authors.initials: C
authors.lastname: Baojjang
authors.forename: Alan
authors.initials: A
authors.lastname: Langnas
authors.forename: Timothy
authors.initials: T
authors.lastname: McCashland
mesh_terms: D000961:Antilymphocyte Serum / Q000494:pharmacology*; D005260:Female; D006526:Hepatitis C / Q000628:therapy*; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents