Author/Authors :
Saidi, R. F. University of Massachusetts Medical School - Division of Organ Transplantation, Department of Surgery, USA , Hertl, M. Harvard Medical School - Massachusetts General Hospital - Department of Surgery-Transplantation Unit, USA , Chung, R. T. Harvard Medical School - Massachusetts General Hospital - Gastrointestinal Unit, Department of Medicine, USA , Ko, D. S. C. Harvard Medical School - Massachusetts General Hospital - Department of Surgery-Transplantation Unit, USA , Kawai, T. Harvard Medical School - Massachusetts General Hospital - Department of Surgery-Transplantation Unit, USA , Markmann, J. Harvard Medical School - Massachusetts General Hospital - Transplantation Unit, Department of Surgery, USA , Bhan, A. K. Harvard Medical School - Massachusetts General Hospital - Department of Pathology, USA , Cosimi, A. B. Harvard Medical School - Massachusetts General Hospital - Transplantation Unit, Department of Surgery, USA , Elias, N. Harvard Medical School - Massachusetts General Hospital - Transplantation Unit, Department of Surgery, USA
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) 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.
Keywords :
Liver transplantation , Hepatitis C , Induction , Recurrence
