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

Area of Science:

• Hepatology
• Transplantation Immunology
• Virology

Background:

• Hepatitis C (HCV) is the primary indication for liver transplantation in the United States.
• Steroids are known to stimulate viral replication, prompting investigation into steroid-free immunosuppression strategies.

Purpose of the Study:

• To evaluate the safety and efficacy of steroid-free immunosuppression using rabbit antithymocyte globulin (RATG) in liver transplant recipients with HCV.
• To compare outcomes between a steroid-based immunosuppression group and a RATG-based immunosuppression group.

Main Methods:

• A retrospective study comparing two groups of liver transplant recipients for HCV from 1995-2007.
• Steroid group (n=81): Calcineurin inhibitor (CNI) plus steroids.
• RATG group (n=73): RATG induction followed by CNI and azathioprine.

Main Results:

• No significant differences in 1- and 3-year patient/allograft survival rates between groups.
• Comparable incidence of acute rejection, biopsy-proven HCV recurrence, and chronic rejection.
• Significantly longer mean time to HCV recurrence in the RATG group (16.2 vs. 9.2 months, p=0.008).
• A trend towards lower incidence of severe portal fibrosis in the RATG group (4% vs. 14%, p=0.07).

Conclusions:

• RATG induction is a safe and effective alternative to steroid-based immunosuppression after liver transplantation for HCV.
• RATG does not alter the incidence of HCV recurrence or affect patient/allograft survival.
• RATG is associated with a significant delay in HCV recurrence and a potential reduction in rejection and portal fibrosis.