INTRODUCTION: Rabbit antithymocyte globulin (rATG) use in liver transplantation is uncommon. At our center, induction therapy is comprised of rATG dosed at 1 – 2 mg/kg based on actual body weight which allows for steroid free immunosuppression. This study sought to determine whether the rATG dosage, the Model for End stage Liver Disease (MELD) score, race, or weight of the patient affected rejection and infection rates in the liver transplant population.

METHODOLOGY: This study was a single center, retrospective chart review of 204 consecutive adult liver transplant recipients who were transplanted between January 1, 2011 and October 26, 2014. 19 patients were excluded; 7 patients received a multi-organ transplant, 3 expired intra-operatively, and 9 patients received a basiliximab induction.

Patients who met inclusion criteria were stratified by rejection status, infection status, race, and weight. Statistical analyses of these populations were examined using a Welch 2-sample t-test, Fisher exact test, and logistic regression in RStudio Version 0.98.1103.

RESULTS: The overall rejection rate within the first month of transplant was 21.1% (39/185 patients). The mean age of those who experienced acute rejection within the first month after transplant was statistically lower than those who did not reject (53 vs. 58 years). We found no statistically significant relationship between rejection and ATG dose, MELD score, or infection status (p=0.917, p=0.318, and 0.522).

The overall infection rate within the first month of transplant was 27.6% (51/185 patients). The majority of infections were urinary and respiratory infections, and were either bacterial or fungal in nature. A statistically significant association between MELD score and infection rate was found; as the MELD increased, the odds of infection increased by a factor of 1.05 (p=0.001). There was no relationship found between the rATG dose and infection status. We also found no effect of race or weight on rejection or infection rates.

CONCLUSION: In this retrospective analysis of liver transplant recipients, we found that patients who reject tend to be statistically younger, and that infection rates increased as lab MELD increased. We found no association between rATG dose, race, or infection on rejection rates, nor did we find any effect of rATG dose or presence of rejection on infection rates. We also found no difference in rejection or infection rates between obese and non-obese patients.

CITATION INFORMATION: Imai R, Wang U. A Retrospective Analysis of Rabbit Antithymocyte Globulin Dosing, MELD, Race, and Weight on Infection and Rejection Rates in Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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