Anti-thymocyte globulin for the treatment of acute cellular rejection following liver transplantation

Timothy M. Schmitt, Melissa Lapinska, Robert G. Sawyer, Patrick Northup, Klaus D. Hagspiel, Timothy L. Pruett, Hugo J.R. Bonatti

Research output: Contribution to journalArticle

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Abstract

Introduction: Acute cellular rejection (ACR) post-liver transplantation (LT) can usually be reversed with pulse dose steroids. Anti-thymocyte globulin (ATG) is used to treat steroid-resistant rejection (SRR). Patients and Methods: We report 15 male and five female LT recipients with a median age of 48.3 (range 14.3-71.7) years, who received ATG for biopsy-proven steroid-resistant rejection (n = 13), severe rejection (6), and severe rejection/recurrent autoimmune hepatitis (n = 1) median 42 (range 6-2,456) days following LT. Results: Underlying liver diseases included HCV (n = 7), alcoholic cirrhosis (n = 3), NASH (n = 2), HBV (n = 2), autoimmune hepatitis (n = 1), PSC (n = 1), miscellaneous (n = 4) including three re LTs. All patients responded to treatment (median AST declined from 172 to 34U/l, median total bilirubin from 9.1 to 1.3 mg/dl; p < 0.001). Three patients developed recurrent ACR, and none chronic rejection. All HCV patients developed recurrence with significant rises in HCV RNA levels. Infections included pneumonia, sepsis, intraabdominal infection, chronic diarrhea, wound infection, EBV, and CMV disease. After a median follow-up of 65.5 (range 4.3-101.7) months post-ATG and median 67.7 (range 9.3-306.3) months post-LT, 17 patients are alive, two died from sepsis/multi-organ failure and one from HCV recurrence. Conclusion: ATG effectively reversed severe and SSR; HCV recurrence and infections remain significant complications.

Original languageEnglish (US)
Pages (from-to)3224-3234
Number of pages11
JournalDigestive Diseases and Sciences
Volume55
Issue number11
DOIs
StatePublished - Nov 1 2010
Externally publishedYes

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Antilymphocyte Serum
Liver Transplantation
Autoimmune Hepatitis
Steroids
Recurrence
Sepsis
Intraabdominal Infections
Therapeutics
Alcoholic Liver Cirrhosis
Wound Infection
Infection
Human Herpesvirus 4
Bilirubin
Liver Diseases
Diarrhea
Pneumonia
RNA
Biopsy

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology

Cite this

Schmitt, T. M., Lapinska, M., Sawyer, R. G., Northup, P., Hagspiel, K. D., Pruett, T. L., & Bonatti, H. J. R. (2010). Anti-thymocyte globulin for the treatment of acute cellular rejection following liver transplantation. Digestive Diseases and Sciences, 55(11), 3224-3234. https://doi.org/10.1007/s10620-010-1149-x

Anti-thymocyte globulin for the treatment of acute cellular rejection following liver transplantation. / Schmitt, Timothy M.; Lapinska, Melissa; Sawyer, Robert G.; Northup, Patrick; Hagspiel, Klaus D.; Pruett, Timothy L.; Bonatti, Hugo J.R.

In: Digestive Diseases and Sciences, Vol. 55, No. 11, 01.11.2010, p. 3224-3234.

Research output: Contribution to journalArticle

Schmitt, Timothy M. ; Lapinska, Melissa ; Sawyer, Robert G. ; Northup, Patrick ; Hagspiel, Klaus D. ; Pruett, Timothy L. ; Bonatti, Hugo J.R. / Anti-thymocyte globulin for the treatment of acute cellular rejection following liver transplantation. In: Digestive Diseases and Sciences. 2010 ; Vol. 55, No. 11. pp. 3224-3234.
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AB - Introduction: Acute cellular rejection (ACR) post-liver transplantation (LT) can usually be reversed with pulse dose steroids. Anti-thymocyte globulin (ATG) is used to treat steroid-resistant rejection (SRR). Patients and Methods: We report 15 male and five female LT recipients with a median age of 48.3 (range 14.3-71.7) years, who received ATG for biopsy-proven steroid-resistant rejection (n = 13), severe rejection (6), and severe rejection/recurrent autoimmune hepatitis (n = 1) median 42 (range 6-2,456) days following LT. Results: Underlying liver diseases included HCV (n = 7), alcoholic cirrhosis (n = 3), NASH (n = 2), HBV (n = 2), autoimmune hepatitis (n = 1), PSC (n = 1), miscellaneous (n = 4) including three re LTs. All patients responded to treatment (median AST declined from 172 to 34U/l, median total bilirubin from 9.1 to 1.3 mg/dl; p < 0.001). Three patients developed recurrent ACR, and none chronic rejection. All HCV patients developed recurrence with significant rises in HCV RNA levels. Infections included pneumonia, sepsis, intraabdominal infection, chronic diarrhea, wound infection, EBV, and CMV disease. After a median follow-up of 65.5 (range 4.3-101.7) months post-ATG and median 67.7 (range 9.3-306.3) months post-LT, 17 patients are alive, two died from sepsis/multi-organ failure and one from HCV recurrence. Conclusion: ATG effectively reversed severe and SSR; HCV recurrence and infections remain significant complications.

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