Induction therapy with either anti-CD25 monoclonal antibodies or rabbit antithymocyte globulins in liver transplantation for hepatitis C


Prof. L. Rostaing, Department of Nephrology, Dialysis and Multiorgan Transplantation, CHU Rangueil, 1 avenue jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France.
Tel.: (+33) 5 61 32 26 84; fax: (+33) 5 61 32 28 64;


Abstract:  Background:  Hepatitis C virus (HCV)-related end-stage liver disease (ESLD) is the leading cause for orthotopic liver transplantation (OLT). The aim of our sequential study was to assess the safety and efficacy of induction therapy using either rabbit antithymocyte globulins (RATG) or anti-CD25 monoclonal antibodies.

Methods:  From January 2000 to January 2003, 31 patients underwent OLT for HCV-related ESLD, and survived more than 1 month post-transplantation. Up to July 2001, induction relied on RATG (Thymoglobulins®; Sangstat, Lyon, France) which was given for a median of 5 d, i.e. a total dose of 406 ± 45 mg (n = 16; group I). Thereafter, induction was based on either basiliximab or dacluzimab (n = 15; group II). Steroids and tacrolimus (from day 1 onwards) were given as maintenance therapy. The primary end-points were at 6 months post-transplantation.

Results:  Patient and graft survivals were excellent and similar in both groups. The acute rejection rate was 37.5% in group I and 20% in group II (p = ns). The rates of serious bacterial and fungal infections as well as cytomegalovirus infections were similar in both groups. Even if the overall pattern of post-transplant liver enzymes did not differ between the two groups, the rate of HCV recurrence tended to be higher in group II (80%) compared with group I (56.25%; p = ns) patients. Both induction therapies were clinically and biologically well tolerated.

Conclusion:  RATG induction therapy is as efficient and as safe as induction with anti-CD25 monoclonal antibodies.