Antithymocyte Globulin Use for Corticosteroid Nonresponsive Rejection After Liver Transplantation

• Published in: Transplantation proceedings Vol. 50; no. 10; pp. 3606 - 3614
• Main Authors: Palmer, W.C., Taner, C.B., Keaveny, A.P., Nakhleh, R.E., Nguyen, J.H., Rosser, B.G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2018
• 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
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2018.09.001

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.