BACKGROUND: Use of induction therapy in liver transplantation is debatable. We aimed to compare clinical outcomes of different induction protocols in liver transplant recipients.

METHODS: Retrospective cohort analysis using the University of Washington Transplant Database from January 2005-December 2012 for adult (age>18 year old) primary liver transplants. All patients received induction therapy. Maintenance immunosupression was tacrolimus or tacrolimus/mycophenolate mophetil. Primary endpoints were acute cellular rejection, patient and graft survival. In patients with chronic hepatitis C (HCV), degree of histologic inflammation/fibrosis at 1 year was assessed. Cox Proportional Hazards were used to evaluate variables associated with patient and graft survival.

RESULTS: We identified 595 patients. 322 received r-ATG and 273 IL-2R blocker. Demographic data was equivalent in both groups. Acute cellular rejection was higher with IL-2R blocker (27% vs 18% p<0.03). Both patient and graft survival were superior with r-ATG at 1, 3 and 5 years ([94.7% vs 92.3%; 90% vs 86%; 87.8% vs 80.6%]; [93.1% vs 89.7%; 88.2% vs 83.5%; 86% vs 78.7%], p<.002; respectively). In HCV, the degree of histologic inflammation/fibrosis at 1 year was not statistically significant. Female recipient, MELD and HCC were associated with less favorable patient and graft survival.

CONCLUSIONS: Although still controversial, we showed that r-ATG is associated with lower rejection rate and improved patient and graft survival in liver transplantation. Type of therapy does not have any impact in the degree of histologic HCV recurrence.

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