Antithymocyte Globulin Induction Therapy in Hepatitis C–Positive Liver Transplant Recipients

Horton, P. W.; Barkun, J.; Rochon, Caroline; Chaudhury, Prosanto; Znajda, Tammy; Martinie, John B.; Metrakos, Peter

doi:10.1016/j.gassur.2005.06.020

Cited by 16 publications

(8 citation statements)

References 25 publications

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“…The event rate of acute cellular rejection (and consequently of bolus steroid use) may therefore have simply been too low to allow detection as an independent predictor of disease progression. This observation is also compatible with the recent study from Horton et al30 reporting a lower incidence of acute cellular rejection in a cohort of 76 HCV patients receiving ATG as induction therapy following a cadaveric LT. ATG induction did not increase the risk of HCV‐related graft loss or patient death in the latter study. These observations together encourage the use of ATG induction therapy in HCV‐positive recipients.…”

Section: Discussionsupporting

confidence: 92%

Early diagnostic potential for hepatocellular carcinoma using the SELDI ProteinChip system†

et al. 2007

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Early detection of HCC increases the potential for curative treatment and improves survival. To facilitate early detection of HCC, this study sought to identify novel diagnostic markers of HCC using surface-enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF/MS) ProteinChip technology. Serum samples were obtained from 153 patients with or without HCC, all of whom had been diagnosed with HCV-associated chronic liver disease. To identify proteins associated with HCC, serum samples were analyzed using SELDI-TOF/MS. We constructed an initial decision tree for the correct diagnosis of HCC using serum samples from patients with (n ‫؍‬ 35) and without (n ‫؍‬ 44) HCC. Six protein peaks were selected to construct a decision tree using this first group. The efficacy of the decision tree was then assessed using a second group of patients with (n ‫؍‬ 29) and without (n ‫؍‬ 33) HCC. The sensitivity and specificity of this decision tree for the diagnosis of HCC were 83% and 76%, respectively. For a third group, we analyzed sera from seven patients with HCC obtained before the diagnosis of HCC by ultrasonography (US) and from five patients free of HCC for the past 3 years. Use of these diagnostic markers predicted the diagnosis of HCC in six of these seven patients before HCC was clinically apparent without any false positives. Conclusion: Serum profiling using the SELDI ProteinChip system is useful for the early detection and prediction of HCC in patients with chronic HCV infection. (HEPATOLOGY 2007;45:948-956.) A pproximately 170 million people worldwide are infected with HCV, which when persistent can progress to HCC. The incidence of HCC is rising; in the United States over the past 2 decades, age-specific incidence has shifted toward younger people. 1 IFN or combined IFN and ribavirin, which are currently the only effective treatments for chronic hepatitis C, reduce the occurrence of HCC. 2,3 Some patients, however, do not receive IFN treatment or fail to clear HCV even with IFN treatment. In addition, a subset of individuals remain unaware that they are infected with HCV; in these patients, HCC may present only in the advanced stage. The prognosis of patients presenting with symptoms related to HCC is extremely poor. In contrast, early detection of HCC before the onset of clinical symptoms can lead to curative treatment, significantly improving prognosis.Several methods developed for the diagnosis of HCC, including evaluation of serum markers, ultrasonography (US), computed tomography (CT), and magnetic resonance imaging, have been tested clinically. Alpha-fetoprotein (AFP) and des-gamma carboxy prothrombin (DCP), serum proteins that are elevated in HCC, have been the most widely used markers. Although routine screening offers the best chance for early tumor detection and improved survival, the reported sensitivities and specificities of elevated serum AFP and DCP levels vary significantly. [4][5][6][7][8][9] In addition, AFP levels are elevated in only 30% to 40% of patients with HCC, par...

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Section: Discussionsupporting

confidence: 92%

Early diagnostic potential for hepatocellular carcinoma using the SELDI ProteinChip system†

et al. 2007

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“…However, its use in liver transplant remains controversial. [3][4][5] When our program transitioned to rATG from the IL-2R blocker, we hypothesized that this change in induction protocol would be associated with a decreased rate of ACR and perhaps improved patient and graft survival. This study demonstrates that the use of rATG as induction therapy in liver transplant is associated with a significant drop in the rate of acute rejection and improved patient and graft survival compared with IL-2R blockers.…”

Section: Discussionmentioning

confidence: 99%

“…Horton and associates had previously demonstrated that the use of rATG had no significant effect on either overall graft survival or patient survival in HCV-positive recipients. 5 Eason and associates in a randomized clinical trial evaluating steroid-free induction reported that 9 of 18 patients (50%) randomized to rATG and 12 of 17 (71%) assigned to the standard therapy have both biochemical and histologic evidence of HCV, showing a trend for lower frequency of HCV recurrence in the patients who received rATG. 15 More recently, McCashland and associates randomized HCV-positive patients to receive rATG versus no induction therapy during liver transplant.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have suggested that the use of induction agents is associated with a decreased incidence of ACR, no detrimental effect in posttransplant recurrence of hepatitis C virus (HCV), improvement in postoperative renal function, and improved patient and graft survival compared with noninduction therapy protocols. [3][4][5] However, it has also been shown that the use of rabbit antithymocyte globulin (rATG) as induction therapy or therapy of steroid-resistant ACR is associated with increased risk of aggressive HCV recurrence. [6][7][8] Since 2000, our standard antibody induction protocol has included an interleukin 2 receptor (IL-2R) antibody.…”

Section: Introductionmentioning

confidence: 99%

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Montenovo

Jalikis²,

Li³

et al. 2017

Exp Clin Transplant

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Objectives: The use of induction therapy in liver transplant is debatable. We aimed to compare clinical outcomes of different induction protocols in liver transplant recipients. Materials and Methods: This was a retrospective cohort analyses using the University of Washington Transplant Database from January 2005 to May 2012 for adult (≥ 18 y old) primary liver transplant patients. All patients received induction therapy. Maintenance immuno suppressive agents were tacrolimus or tacrolimus-mycophenolate mofetil. Primary endpoints were acute cellular rejection, patient survival, and graft survival. In patients with chronic hepatitis C, the degree of histologic inflammation or fibrosis at 1 year was assessed. Cox proportional hazards models were constructed to evaluate variables associated with both patient and graft survival. Results: We identified 595 patients: 322 patients received rabbit antithymocyte globulin and 273 received interleukin 2 receptor blocker. Acute cellular rejection was higher in patients who received interleukin 2 receptor blocker than in patients who received rabbit antithymocyte globulin (27% vs 18%; P < .03). Both patient survival at 1 year (95% vs 90%), 3 years (92% vs 87%), and 5 years (86% vs 80%) and graft survival at 1 year (93% vs 88%), 3 years (90% vs 86%), and 5 years (83% vs 78%) were superior with rabbit antithymocyte globulin than with the interleukin 2 receptor blocker (P < .002). In patients with hepatitis C virus, type of induction therapy did not have any effect on the timing of hepatitis C virus recurrence. At 1 year after transplant, 33.3% in the rabbit antithymocyte globulin group had grade 3/4 inflammation and 10.2% had stage 3/4 fibrosis, compared with 16.8% and 4.8% in the interleukin 2 receptor blocker group (P ≤ .002 and not significant). Female recipient, Model for End-Stage Liver Disease score, hepatocellular carcinoma, and high preoperative serum creatinine levels were associated with less favorable patient and graft survival. Conclusions: Rabbit antithymocyte globulin is associated with lower rejection rate and improved patient and graft survival in liver transplant. Type of therapy affects the degree of histologic hepatitis C virus recurrence.

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“…Horton et al [68] reported a retrospective analysis of 142 HCV (þ) liver-transplant recipients. They compared ATG induction versus no ATG induction and found that the incidence of biopsyproven acute rejection was lower in patients who received ATG induction.…”

Section: Polyclonal Antibodies: Antithymocyte Globulinmentioning

confidence: 99%

Immunosuppression in HCV-positive liver-transplant recipients

Chan¹,

Lake

2012

Current Opinion in Organ Transplantation

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HCV (+) transplant recipients present unique challenges. Over the years, there has been progress but there is clearly no consensus regarding the optimal immunosuppressive medications or drug regimens; however, there continues to be advancements in the management of patients with HCV. Though current studies do not provide clear evidence as to optimal immunosuppression, they do identify questions ideally addressed by large, randomized controlled trials.

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Antithymocyte Globulin Induction Therapy in Hepatitis C–Positive Liver Transplant Recipients

Cited by 16 publications

References 25 publications

Early diagnostic potential for hepatocellular carcinoma using the SELDI ProteinChip system†

Early diagnostic potential for hepatocellular carcinoma using the SELDI ProteinChip system†

Untitled

Immunosuppression in HCV-positive liver-transplant recipients

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