Antithymocyte Globulin Use for Corticosteroid Nonresponsive Rejection After Liver Transplantation

Area of Science:

• Transplantation immunology
• Gastroenterology
• Nephrology

Background:

• Acute cellular rejection is a common complication following liver transplantation.
• Corticosteroids are the standard treatment, but some cases are nonresponsive.
• Alternative therapies are needed for refractory rejection episodes.

Purpose of the Study:

• To evaluate the efficacy and outcomes of antithymocyte globulin (ATG) therapy.
• To assess ATG use in liver transplant recipients with corticosteroid-nonresponsive acute cellular rejection.
• To compare long-term survival in patients treated with ATG versus those who did not require it.

Main Methods:

• Retrospective review of liver transplant recipients from 2002-2010.
• Identification of patients treated with ATG for corticosteroid-nonresponsive rejection.
• Analysis of rejection resolution, graft survival, and patient survival.

Main Results:

• Twenty patients received ATG for 21 episodes of nonresponsive rejection.
• 90% of rejection episodes showed histological improvement within 7 days of ATG treatment.
• Three-year graft and patient survival rates were 60% and 65% for ATG-treated patients, versus 79% and 84% for controls.

Conclusions:

• Antithymocyte globulin is an effective short-term treatment for corticosteroid-nonresponsive acute cellular rejection.
• Some patients do not respond to ATG therapy.
• Long-term graft and patient survival may be reduced even in responders to ATG therapy.