Conflicts of Interest Declaration of no conflict of interest.
Outcome of induction immunosuppression for liver transplantation comparing anti-thymocyte globulin, daclizumab, and corticosteroid
Article first published online: 23 MAR 2011
© 2011 The Authors. Transplant International © 2011 European Society for Organ Transplantation
Volume 24, Issue 7, pages 640–650, July 2011
How to Cite
Uemura, T., Schaefer, E., Hollenbeak, C. S., Khan, A. and Kadry, Z. (2011), Outcome of induction immunosuppression for liver transplantation comparing anti-thymocyte globulin, daclizumab, and corticosteroid. Transplant International, 24: 640–650. doi: 10.1111/j.1432-2277.2011.01250.x
- Issue published online: 13 JUN 2011
- Article first published online: 23 MAR 2011
- Received: 22 September 2010 Revision requested: 19 October 2010 Accepted: 21 February 2011
- anti-thymocyte globulin;
- hepatitis C;
- liver transplantation;
- renal function;
- United Network for Organ Sharing
In addition to standard corticosteroid induction, anti-thymocyte globulin (ATG) or daclizumab as induction immunosuppression has been reported for liver transplantation. However, the effects and long-term outcomes of antibody induction therapy are not well known, especially for hepatitis C (HCV). The United Network for Organ Sharing (UNOS) database was utilized to analyze 16 898 adult primary liver transplant patients who received ATG alone (n = 452), ATG and steroids (ATG + S) (n = 1758), daclizumab alone (n = 683), or steroid alone (n = 14 005), listed as induction immunosuppression. Graft and patient survival, and donor and recipient factors for survival were analyzed for HCV and all liver diseases. For patients with HCV, ATG + S had significantly inferior graft survival compared with daclizumab (P = 0.01) and steroids (P = 0.03). The Cox proportional hazards model also showed that ATG + S was a marginal risk factor for graft failure (P = 0.05). On the other hand, for patients with all the liver diseases, graft and patient survival were not significantly different between induction regimens. ATG induction appeared to be preferentially used in patients with renal dysfunction, with improvement in renal function after liver transplantation. Thus, ATG induction can be used for patients with renal dysfunction in non-HCV diseases. Daclizumab induction achieved satisfactory short-term and long-term outcomes of liver transplantation in all the liver diseases including HCV disease.