Steroid-free Liver Transplantation Using Rabbit Antithymocyte Globulin Induction in 500 Consecutive Patients

Yoo, Min C.; Vanatta, Jason M.; Modanlou, Kian A.; Campos, Luís; Nezakatgoo, Nosratollah; Nair, Satheesh; Eason, James D.

doi:10.1097/tp.0000000000000477

Cited by 21 publications

(17 citation statements)

References 23 publications

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“…In a nonrandomized single-center trial, a steroid-free regimen and weaning to single-agent Tac or SRL at 3 months after thymoglobulin induction yielded 1- and 5-year patient and graft survival comparable to national averages in registry data. 15 In a meta-analysis of liver transplant recipients, AR was significantly less frequent when any form of T cell–specific antibody induction was used compared with no induction (relative risk, 0.85; P <0.05). 16 The meta-analysis did not mirror typical practice patterns in the US, however, as included studies were limited to 19 trials with corticosteroids administered in all and MPA/AZA in 15 of the 19 trials.…”

Section: Discussionmentioning

confidence: 99%

Center-driven and Clinically Driven Variation in US Liver Transplant Maintenance Immunosuppression Therapy: A National Practice Patterns Analysis

Nazzal

Lentine

Naik

et al. 2018

Transplantation Direct

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Section: Discussionmentioning

confidence: 99%

Center-driven and Clinically Driven Variation in US Liver Transplant Maintenance Immunosuppression Therapy: A National Practice Patterns Analysis

Nazzal

Lentine

Naik

et al. 2018

Transplantation Direct

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“…( 26,30 ) Prior studies have examined trends in renal function after LT, suggesting a role for AI, particularly in DCD recipients. ( 3,31 ) Aside from decreasing the sequelae of IRI on recipient renal function, induction therapy may provide an umbrella of immunosuppression, allowing the delayed introduction of calcineurin inhibitors.…”

Section: Discussionmentioning

confidence: 99%

Immunosuppression in Donation After Circulatory Death Liver Transplantation: Can Induction Modify Graft Survival?

et al. 2020

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Recipients of donation after circulatory death (DCD) LTs historically have an increased risk of graft failure. Antibody induction (AI) with antithymocyte globulin (ATG) or anti‐interleukin 2 receptor (anti‐IL2R) immunotherapy may decrease the incidence of graft failure by mitigating ischemia/reperfusion injury. A retrospective review of the United Network for Organ Sharing (UNOS) database for LTs between 2002 and 2015 was conducted to determine whether ATG or anti‐IL2R AI was associated with graft survival in DCD. A secondary endpoint was postoperative renal function as measured by estimated glomerular filtration rate at 6 and 12 months. Among DCD recipients, ATG (hazard ratio [HR] = 0.71; P = 0.03), but not anti‐IL2R (HR = 0.82; P = 0.10), was associated with a decrease in graft failure at 3 years when compared with recipients without AI. ATG (HR = 0.90; P = 0.02) and anti‐IL2R (HR = 0.94; P = 0.03) were associated with a decreased risk of graft failure in donation after brain death (DBD) liver recipients at 3 years compared with no AI. When induction regimens were compared between DCD and DBD, only ATG (HR = 1.19; P = 0.19), and not anti‐IL2R (HR = 1.49; P < 0.01) or no AI (HR = 1.77; P < 0.01), was associated with similar survival between DCD and DBD. In conclusion, AI therapy with ATG was associated with improved longterm liver allograft survival in DCD compared with no AI. ATG was associated with equivalent graft survival between DCD and DBD, suggesting a beneficial role of immune cell depletion in DCD outcomes.

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“…Our center has been using a corticosteroid-free immunosuppression protocol, 6 which consists of induction immunosuppression with RATG given in 2 doses of 1.5 mg/kg. The first dose is given during the anhepatic phase; and the second dose is given on posttransplant day 2.…”

Section: Methodsmentioning

confidence: 99%

“…We have recently published our experience in the largest series of OLT recipients using a steroid-free protocol with rabbit antithymocyte globulin (RATG) induction demonstrating excellent outcomes, low complication rates, and preservation of renal function with rejection occurring in 22.8% patients, 6.6% patients requiring steroids. 6 In the current study, we describe our experience with dual immunosuppression use in a steroid-free protocol and analyze its effect on autoimmune liver disease recurrence rates, incidence of acute cellular rejection (ACR) post-LT, overall and regraft-free survival, and the incidence of complications in terms of sepsis and risk for posttransplant malignancy.…”

mentioning

confidence: 99%

Outcomes of Liver Transplant Recipients With Autoimmune Liver Disease Using Long-Term Dual Immunosuppression Regimen Without Corticosteroid

Jones

Vanatta

Kamal

et al. 2017

Transplantation Direct

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BackgroundLiver transplant (LT) recipients with autoimmune liver disease (primary sclerosing cholangitis, primary biliary cholangitis, autoimmune hepatitis) are at increased risk of developing acute cellular rejection (ACR), and in many cases graft failure due to recurrent disease. We describe our experience with dual immunosuppression without steroid maintenance and analyze its effect on disease recurrence; ACR; patient and graft survivals; and complications, such as sepsis and de novo malignancy.MethodsWe included 74 consecutive LT recipients (April 2006 to April 2013) with autoimmune liver disease (primary sclerosing cholangitis, 20; primary biliary cholangitis, 23; autoimmune hepatitis, 31) from a single transplant center. Immunosuppression protocol included rabbit antithymocyte globulin for induction and mycophenolate mofetil with tacrolimus or sirolimus/everolimus indefinitely for maintenance.ResultsOverall 1-, 3-, 5-, and 7-year patient survival was 95.9%, 90.4%, 82,2% and 74.9%, re–graft-free survival was 93.2%, 86.3%, 79.9%, and 72.8%, respectively (median follow-up, 5.5 years). In a multivariate Cox regression analysis, sepsis during post-LT period (P = 0.040; hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.04-6.11), steroid use for ACR (P = 0.037; HR, 2.60; 95% CI, 1.06-6.34), and younger age (<40 years) at LT (P = 0.038; HR, 2.53; 95% CI, 1.05-6.10) predicted graft survival, whereas steroid use for ACR was the only variable that was predictive of overall patient survival (P = 0.004; HR, 4.10; 95% CI, 1.59-10.52). Overall, 34 biopsy-proven ACR was noted in 22 LT recipients (30%), 13 (17.5%) had disease recurrence, and 34 episodes of sepsis occurred in 19 patients.ConclusionsDual immunosuppression protocol in LT recipients with autoimmune liver disease without corticosteroid maintenance had acceptable rates of survival and ACR without predisposing patients to the adverse effects of long-term steroid therapy.

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Steroid-free Liver Transplantation Using Rabbit Antithymocyte Globulin Induction in 500 Consecutive Patients

Abstract: This is the largest reported series of OLT recipients using a steroid-free protocol with RATG induction demonstrating excellent outcomes, low complication rates, and preservation of renal function.

Cited by 21 publications

References 23 publications

Center-driven and Clinically Driven Variation in US Liver Transplant Maintenance Immunosuppression Therapy: A National Practice Patterns Analysis

Center-driven and Clinically Driven Variation in US Liver Transplant Maintenance Immunosuppression Therapy: A National Practice Patterns Analysis

Immunosuppression in Donation After Circulatory Death Liver Transplantation: Can Induction Modify Graft Survival?

Outcomes of Liver Transplant Recipients With Autoimmune Liver Disease Using Long-Term Dual Immunosuppression Regimen Without Corticosteroid

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