rATG has gained acceptance for induction in liver transplantation. However, due to its strength as an immunosuppressive agent, there is concern that it may be deleterious in liver transplantation for HCV. We test the hypothesis that the use of rATG in liver transplantation for HCV results in worse patient survival. Methods: All 385 patients with documented HCV transplanted at our center from 1/1/2000 through 1/1/2009 (to allow for 3 years follow up) were analyzed using our longitudinal database. Induction was given to 367 recipients: either basiliximab (Simulect) (n = 276) or rabbit ATG (rATG, thymoglobulin) (n = 91). Clinically indicated and surveillance biopsies were analyzed using the Batts Ludwig scale to characterize HCV activity (grade: 0-4) and fibrosis (stage: 0-4). Statistics: t tests, Chi square tests, and, to compare survival, the Log rank and Cox proportional hazards tests were used. Results: There was no difference in patient survival between rATG and Simulect (p = 0.5).

There was no significant difference in the rates of rejection between the two groups (16% in rATG vs. 22%, p = 0.3). There was no difference severe in HCV activity (≥grade 3: rATG 31% vs. 31%, p = 1.0). There was, however, a lower rate of severe fibrosis in the rATG group (≥stage 3: 21% vs. 33%, p = 0.04). In the Cox multivariate model, only increasing donor age, female gender, acute rejection, and ≥ grade 3 fibrosis were statistically significant risk factors for worse patient survival. Two year creatinine was better with rATG (0.8 vs. 1.2 mg/dl, p < 0.0001).Conclusions: Compared to Simulect, rATG is not associated with worse survival in liver transplantation for HCV. rATG, however, appears to be associated with a lower rate of severe fibrosis in these patients. Advanced donor age, female gender, rejection, and severe fibrosis were risk factors for worse survival in these recipients with HCV. In addition, creatinine appears to be lower at two years in recipients who received ATG.

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