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Promising early results with immunosuppression using rabbit anti‐thymocyte globulin and steroids with delayed introduction of tacrolimus in adult liver transplant recipients
Author(s) -
Tector A. Joseph,
Fridell Jonathan A.,
Mangus Richard S.,
Shah Ashesh,
Milgrom Martin,
Kwo Paul,
Chalasani Naga,
Yoo Hwan,
Rouch Dale,
Liangpunsakul Suthat,
Herring Scott,
Lumeng Lawrence
Publication year - 2004
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20085
Subject(s) - medicine , tacrolimus , immunosuppression , liver transplantation , anti thymocyte globulin , gastroenterology , surgery , transplantation
Induction therapy with T‐cell depleting drugs in liver transplantation is controversial. This study examined the use of rabbit antithymocyte globulin (RATG) with delayed introduction of tacrolimus in liver transplant recipients. Additional subgroup analysis compared patients with or without hepatitis C (HCV) cirrhosis. Over 17 months, 116 adults received 120 liver allografts. Four patients who died before receiving RATG were excluded. Immunosuppression included steroids, 3 doses of RATG (2 mg/kg), and tacrolimus started on postoperative day 3 to 4. Ninety‐six percent of patients were alive with a mean follow‐up of 12.9±4.5 months. No graft was lost to rejection. Two patients developed hepatic artery thrombosis. Six percent of patients had acute rejection. No patient had steroid resistant or recurrent rejection. RATG related drug events were limited to fever, chills, tachycardia, and oxygen desaturation. There were no cases of lymphoproliferative disease. Forty‐two percent of patients were transplanted for HCV. Thirty‐two percent of HCV‐patients had biopsy proven hepatitis C recurrence occurring at 4 weeks to 10 months posttransplant. RATG induction therapy is associated with good patient and graft survival, a low incidence of rejection, and minimal side effects. In addition, RATG induction is safe in patients transplanted for HCV. (Liver Transpl 2004;10:404–407.)