Induction with Rabbit Antithymocyte Globulin following Orthotopic Liver Transplantation for Hepatitis C

• Main Authors: R. F. Saidi, M. Hertl, T. Chung, D. S. C. Ko, T. Kawai, J. Markmann, A. K. Bhan, A. B. Cosimi, N. Elias1
• Format: Article
• Language: English
• Published: Shiraz University of Medical Sciences 2011-10-01
• Series: International Journal of Organ Transplantation Medicine
• Subjects: Liver transplantation; Hepatitis C; Induction; Recurrence
• Online Access: http://home.sums.ac.ir/~habibzaf/ojs/index.php/IJOTM/article/view/90/165

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 immu-nosuppression might be a safer approach. Methods: From January 1995 to October 2002, we used steroid plus calcineurin inhibitor (CNI) immuno-suppression 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.