title: Induction with Rabbit Antithymocyte Globulin following Orthotopic Liver Transplantation for Hepatitis C.
abstract: BACKGROUND
  Hepatitis C (HCV) is the most common indication for liver transplantation in the US.
  
  
  OBJECTIVE
  Since steroids are the major stimulus of viral replication, we postulated that steroid-free immunosuppression might be a safer approach.
  
  
  METHODS
  From January 1995 to October 2002, we used steroid plus calcineurin inhibitor (CNI) immunosuppression after liver transplantation for HCV (steroid group, n=81). From October 2002 to June 2007, rabbit antithymocyte globulin (RATG) induction, followed by CNI and azathioprine (RATG group, n=73) was utilized.
  
  
  RESULTS
  There were no differences in 1- and 3-year patient/allograft survival rates. The incidence of acute rejection rate (19% vs. 28%), of biopsy-proven HCV recurrence (70% vs. 75%), and chronic rejection (6% vs. 9%) were comparable. The mean time to develop recurrent HCV was significantly longer in the RATG group (16.2 vs. 9.2 months, p=0.008). The incidence of severe portal fibrosis appears to be lower in RATG group compared to the steroid group; 14% vs. 4% (p=0.07).
  
  
  CONCLUSIONS
  RATG induction is safe and effective after liver transplantation for HCV, but has no impact on the incidence of HCV recurrence and patient/allograft survival. However, a significant delay in time to HCV recurrence and a trend toward less rejection and portal fibrosis was observed.
authors.affiliation: Department of Surgery-Transplantation Unit.
authors.forename: R F
authors.initials: RF
authors.lastname: Saidi
authors.affiliation: Department of Surgery-Transplantation Unit.
authors.forename: M
authors.initials: M
authors.lastname: Hertl
authors.affiliation: Gastrointestinal Unit, Department of Medicine.
authors.forename: R T
authors.initials: RT
authors.lastname: Chung
authors.affiliation: Department of Surgery-Transplantation Unit.
authors.forename: D S C
authors.initials: DS
authors.lastname: Ko
authors.affiliation: Department of Surgery-Transplantation Unit.
authors.forename: T
authors.initials: T
authors.lastname: Kawai
authors.affiliation: Department of Surgery-Transplantation Unit.
authors.forename: J
authors.initials: J
authors.lastname: Markmann
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: Bhan
authors.affiliation: Department of Surgery-Transplantation Unit.
authors.forename: A B
authors.initials: AB
authors.lastname: Cosimi
authors.affiliation: Department of Surgery-Transplantation Unit.
authors.forename: N
authors.initials: N
authors.lastname: Elias
keywords: Hepatitis C; Induction; Liver transplantation; Recurrence