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Titolo:
Steroid-free liver transplantation using rabbit antithymocyte globulin induction: Results of a prospective randomized trial
Autore:
Eason, JD; Loss, GE; Blazek, J; Nair, S; Mason, AL;
Indirizzi:
Ochsner Multiorgan Transplant Ctr, Sect Abdominal Transplantat, New Orleans, LA 70121 USA Ochsner Multiorgan Transplant Ctr New Orleans LA USA 70121, LA 70121 USA
Titolo Testata:
LIVER TRANSPLANTATION
fascicolo: 8, volume: 7, anno: 2001,
pagine: 693 - 697
SICI:
1527-6465(200108)7:8<693:SLTURA>2.0.ZU;2-7
Fonte:
ISI
Lingua:
ENG
Soggetto:
MYCOPHENOLATE-MOFETIL; HEPATITIS-C; REJECTION; IMMUNOSUPPRESSION; CYCLOSPORINE; TACROLIMUS; PREDNISONE; RECIPIENTS; THERAPY; WITHDRAWAL;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
20
Recensione:
Indirizzi per estratti:
Indirizzo: Eason, JD Ochsner Multiorgan Transplant Ctr, Sect Abdominal Transplantat, 1514 Jefferson Hwy, New Orleans, LA 70121 USA Ochsner Multiorgan TransplantCtr 1514 Jefferson Hwy New Orleans LA USA 70121
Citazione:
J.D. Eason et al., "Steroid-free liver transplantation using rabbit antithymocyte globulin induction: Results of a prospective randomized trial", LIVER TRANS, 7(8), 2001, pp. 693-697

Abstract

Steroids have been I of the primary modes of immunosuppression since the inception of transplantation and have been credited with both the preventionand treatment of rejection. Steroids also have been held responsible for increased infections, posttransplantation diabetes, and recurrent hepatitis after orthotopic liver transplantation (OLT). The purpose of this ongoing prospective randomized trial is to eliminate steroid use in OLT through induction with rabbit antithymocyte globulin (RATG). This is the first report of a prospective randomized trial in OLT achieving complete absence of steroids. Seventy-one adult patients were prospectively randomized to administration of RATG or steroids. Thirty-six patients were randomized to the administration of RATG induction at a dose of 1.5 mg/kg intravenously (IV) beginning during the anhepatic phase. No steroids were administered. Patients were administered a second 1.5-mg/kg dose of RATG post-OLT day 1. Thirty-five patients were randomized to the administration of methylprednisolone, whichhad been our standard immunosuppressive protocol. These patients were administered methylprednisolone, 1,000 mg IV, initiated during the anhepatic phase and followed by steroid taper. Maintenance immunosuppression consisted of tacrolimus and mycophenolate, with or without prednisone. Three patientsdied in each group, for an overall survival rate of 91% in each group. Onepatient in each group required re-OLT, for a graft survival rate of 89% ineach group. Seven patients administered RATG had biopsy-proven rejection (20.5%), all of whom were successful; treated by increasing tacrolimus doses. Eleven patients administered steroid had biopsy-proven rejection (32%), 7(64%) of whom required additional steroids for treatment, whereas 4 patients (36%) were successfully treated by increasing tacrolimus doses. The incidence of rejection was not statistically significant; however, there was a significant difference in the incidence of steroid-requiring rejection (P=.01). The incidence of recurrent hepatitis C was 50% in RATG patients and 71% in steroid patients (P=not significant). The incidence and severity of infections complications were slightly lower in RATG patients, accounted for by a greater incidence of cytomegalovirus (CMV) infection in the steroid patients. RATG induction enables complete avoidance of steroid use in OLT with a trend toward a lower rejection rate, decreased incidence of post-OLT diabetes and recurrent hepatitis C, and decreased CMW infection. This prospective randomized trial gives encouraging support that steroids can be safelyeliminated in OLT.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 19/09/20 alle ore 20:56:47