Steroid-free liver transplantation using rabbit antithymocyte globulin and early tacrolimus monotherapy

Eason, James D., Nair, Satheesh, Cohen, Ari J., Blazek, Jamie L. and Loss, George E. (2003). Steroid-free liver transplantation using rabbit antithymocyte globulin and early tacrolimus monotherapy. In: 19th International Congress of the Transplantation-Society, Miami, FL, United States, (1396-1399). 25-30 August 2002. doi:10.1097/01.TP.0000062834.30922.FE

Author Eason, James D.
Nair, Satheesh
Cohen, Ari J.
Blazek, Jamie L.
Loss, George E.
Title of paper Steroid-free liver transplantation using rabbit antithymocyte globulin and early tacrolimus monotherapy
Conference name 19th International Congress of the Transplantation-Society
Conference location Miami, FL, United States
Conference dates 25-30 August 2002
Journal name Transplantation   Check publisher's open access policy
Place of Publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Publication Year 2003
Sub-type Fully published paper
DOI 10.1097/01.TP.0000062834.30922.FE
ISSN 0041-1337
Volume 75
Issue 8
Start page 1396
End page 1399
Total pages 3
Language eng
Formatted Abstract/Summary
Background. In 2001, we published early results of a prospective randomized trial of 71 patients who received either steroids or rabbit antithymocyte globulin (RATG) for orthotopic liver transplantation (OLT). We now report follow-up on these patients and additional patients undergoing steroid-free OLT.

Methods. A total of 119 adult OLT recipients were prospectively randomized to receive either methylprednisolone 1,000 mg followed by a 3-month steroid taper or a steroid-free regimen of RATG 1.5 mg/kg during the anhepatic phase followed by a 1.5 mg/kg dose on posttransplant day 1. Maintenance immunosuppression consisted of tacrolimus and mycophenolate mofetil in both groups. Mycophenolate mofetil was weaned over 3 months in the first 71 patients and over 2 weeks in the last 48 patients, achieving tacroli mus monotherapy by 2 weeks posttransplant. Subsequently, a group of 24 sequential OLT recipients received the steroid-free (RATG) protocol. Endpoints of the study were survival, rejection, infectious complications, posttransplant diabetes, and recurrent hepatitis C virus.

Results. One-year patient survival was 85% in each group of the prospective randomized trial with a mean follow-up of 18.5 months. One-year graft survival was 82% in the RATG group and 80% in the steroid group (P=not significant). Patient and graft survival of the 24 nonrandomized RATG patients was 96% with a mean follow-up of 3 months. The incidence of rejection was not significantly different; however, 50% of the patients in the steroid group required pulse steroids to reverse the rejection compared with only one patient (1.6%) in the RATG group (P=.03). The incidence of cytomegalovirus infection (P<.05) and posttransplant diabetes was higher in the steroid group (P=.03). There was a trend toward decreased severity of hepatitis C virus in the RATG group.

Conclusions. Steroid-free liver transplantation using RATG and early tacrolimus monotherapy effectively reduces immunosuppression-related complications with excellent survival.
Q-Index Code E1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Conference Paper
Collection: School of Medicine Publications
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Created: Mon, 14 Mar 2011, 08:51:31 EST