Induction immunosuppression with rabbit antithymocyte globulin in pediatric liver transplantation

Ashesh Shah, Avinash Agarwal, Richard Mangus, Joel Lim, Jonathan Fridell, Rodrigo Vianna, A. Joseph Tector

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Routine use of rabbit antithymocyte globulin (RATG) induction therapy remains controversial in pediatric liver transplantation. We reviewed our experience of 18 cadaveric liver transplants in 18 children over a span of 2 years. All patients received the same immunosuppression: perioperative steroid therapy with taper, 3 doses of RATG, and maintenance therapy of steroids and tacrolimus started on postoperative day 3. Mean follow-up was 2.2 ± 0.2 years. End-stage liver disease was secondary to biliary atresia in 10 patients (56%) and metabolic disorders in 4 patients (22%). Graft and patient survival were 89%. Serum bilirubin was 1.2 mg/dL, 1.1 mg/dL, 0.5 mg/dL, and 0.5 mg/dL at 1, 3, 6, and 12 months, respectively. The 2 mortalities were secondary to multiple organ system failure. Overall rejection rate was 17% (3/18). Rejection episodes occurred at 4, 6, and 7 months. Two patients were treated with steroids; the third was treated with OKT3. No patient has developed posttransplant lymphoproliferative disease. Serum creatinine was 0.7 mg/dL, 0.6 mg/dL, 0.6 mg/dL, and 0.6 mg/dL at 1, 3, 6, and 12 months, respectively, among surviving patients. In conclusion, our data suggest that RATG induction with steroid and tacrolimus maintenance therapy is safe, easy to use, and effective in the prevention of rejection.

Original languageEnglish
Pages (from-to)1210-1214
Number of pages5
JournalLiver Transplantation
Volume12
Issue number8
DOIs
StatePublished - Aug 2006

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Antilymphocyte Serum
Liver Transplantation
Immunosuppression
Pediatrics
Rabbits
Steroids
Tacrolimus
Biliary Atresia
Muromonab-CD3
End Stage Liver Disease
Multiple Organ Failure
Graft Survival
Therapeutics
Serum
Bilirubin
Creatinine
Transplants
Mortality
Liver

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Induction immunosuppression with rabbit antithymocyte globulin in pediatric liver transplantation. / Shah, Ashesh; Agarwal, Avinash; Mangus, Richard; Lim, Joel; Fridell, Jonathan; Vianna, Rodrigo; Tector, A. Joseph.

In: Liver Transplantation, Vol. 12, No. 8, 08.2006, p. 1210-1214.

Research output: Contribution to journalArticle

Shah, Ashesh ; Agarwal, Avinash ; Mangus, Richard ; Lim, Joel ; Fridell, Jonathan ; Vianna, Rodrigo ; Tector, A. Joseph. / Induction immunosuppression with rabbit antithymocyte globulin in pediatric liver transplantation. In: Liver Transplantation. 2006 ; Vol. 12, No. 8. pp. 1210-1214.
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