Antithymocyte Globulin Use for Corticosteroid Nonresponsive Rejection After Liver Transplantation

Acute cellular rejection after liver transplantation usually responds to intravenous corticosteroids, yet some episodes are corticosteroid-nonresponsive. We report our experience using antithymocyte globulin therapy for corticosteroid-nonresponsive acute cellular rejection in liver transplant recipi...

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Bibliographic Details
Published in:Transplantation proceedings 2018-12, Vol.50 (10), p.3606-3614
Main Authors: Palmer, W.C., Taner, C.B., Keaveny, A.P., Nakhleh, R.E., Nguyen, J.H., Rosser, B.G.
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - therapeutic use
Adult
Antilymphocyte Serum - therapeutic use
Drug Resistance
Female
Graft Rejection - drug therapy
Graft Rejection - mortality
Humans
Immunosuppressive Agents - therapeutic use
Liver Transplantation - mortality
Male
Middle Aged
Retrospective Studies
Transplantation, Homologous
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Summary:Acute cellular rejection after liver transplantation usually responds to intravenous corticosteroids, yet some episodes are corticosteroid-nonresponsive. We report our experience using antithymocyte globulin therapy for corticosteroid-nonresponsive acute cellular rejection in liver transplant recipients. From January 1, 2002 to January 1, 2010, 1436 patients underwent 1548 liver or liver with other organ transplantations at our institution. We identified all patients treated with antithymocyte globulin during this timeframe for corticosteroid-nonresponsive rejection. Twenty patients required antithymocyte globulin for 21 episodes of corticosteroid-nonresponsive rejection. Antithymocyte globulin was started a median (range) of 27 (7–2434) days post-transplantation, and median total antithymocyte globulin dose and duration was 10.5 (7.5–26.25) mg/kg and 7 (5–13) days, respectively. Resolution or marked histological improvement of rejection on Day 7 liver allograft biopsies occurred in 90% of rejection episodes treated with antithymocyte globulin. Three-year graft and patient survival rates were 60% and 65%, respectively, compared with 79% and 84% in patients not requiring antithymocyte globulin. Antithymocyte globulin was an effective therapy for corticosteroid-nonresponsive rejection, with excellent short-term outcomes. Some liver transplant recipients failed to respond, and long-term survival was reduced, even in those who responded to antithymocyte globulin.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2018.09.001