Open AccessPrevalent immunosuppressive strategies in liver transplantation for hepatitis C: results of a multi‐center international survey
Author(s) -
Gedaly Roberto,
Clifford Timothy M.,
McHugh Patrick P.,
Jeon Hoonbae,
Johnston Thomas D.,
Ranjan Dinesh
Publication year - 2008
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/j.1432-2277.2008.00699.x
Subject(s) - immunosuppression , medicine , tacrolimus , regimen , liver transplantation , transplantation , hepatitis c virus , hepatitis c , basiliximab , gastroenterology , immunology , virus
Summary To determine current immunosuppression regimens and strategies for acute cellular rejection in hepatitis C virus (HCV) patients after liver transplantation (LT), questionnaires were sent to 264 LT programs worldwide. Surveys from 81 programs were reviewed. In 27 centers (33.8%) the immunosuppression protocol used in HCV differed from non‐HCV patients. Tacrolimus‐based immunosuppression is utilized in 70 centers (86.42%). Triple therapy using tacrolimus, mycophenolate mofetil and steroids is the most common regimen (41%). Six programs (7.4%) use steroid‐free protocols. In nine centers (11%) steroids are discontinued within a week, 56% within 3 months, and 98% within the first year. At 75% of centers, mild rejection is treated by increasing baseline immunosuppression. Moderate rejection is treated by increasing baseline immunosuppression in 38% of centers, steroid bolus in 44%, and either in 16%. For severe rejection, 46% of centers give bolus steroid, and 16% administer antibodies. Among respondents, non‐US programs use significantly more cyclosporine than US programs (35.6% vs. 2.8%, P < 0.001). Duration of steroid therapy is significantly shorter in US programs than non‐US (10.8 vs. 29.4 weeks, P < 0.001). There is no consensus regarding the best immunosuppressive regimen and rejection treatments in HCV patients after LT. Our results reveal the most prevalent management practices in this difficult group of patients.