Purpose: Rabbit antithymocyte globulin (rATG) is commonly used for induction immunosuppression and treatment of rejection in solid organ transplantation. Previous work has shown that rATG decreases the incidence of biliary complications after DCD liver transplantation (LTx). In this analysis, we assessed the safety of rATG use in DCD liver transplant recipients.

Methods: We performed a retrospective review of 89 adult DCD LTx recipients who were transplanted between 1/1/05-12/21/16. Patients were divided into two cohorts based on receipt of rATG. Outcomes between groups were compared using log-rank tests for survival data and t-tests for comparison of means. In all cases, 0.05 was used as the significance level.

Results: Forty-two patients received rATG (mean dose of rATG was 3.7±1.3 mg/kg) and 57 received no ATG (non-ATG). There was no significant difference in 1 and 3 year graft survival (rATG, 85.5%, 77.2% vs non-ATG 70%, 61.7%, p=0.06) or patient survival (rATG 87.8%, 79.7% vs non-ATG 85.1%, 83%, p=0.89). There was a greater intraoperative use of fresh frozen plasma in the rATG group (9.5 units vs. 5.2 units, p=0.04) and greater use of platelets in the non-ATG group (22.5 units vs. 4.8 units, p=0.001) but no differences in red blood cell transfusion. One year rejection rates trended toward lower rates in the rATG group (26.5% vs 44%, p=0.056). Bacterial infection rates were higher in the non-ATG group at 90 days and 1 year (non-rATG, 54.5% vs. rATG, 24.1% and non-ATG 61.9% vs rATG 33.9% p=0.004) respectively. Fungal infections were higher in the non-ATG group at 90 days and 1 year (32.8% vs 14.5% and 47.6% vs 14.5%, p=0.0006). The were no differences in 1 year CMV infection rates between the groups (non-ATG 2.6% vs. rATG 7.9% p=0.3).

Conclusion: Based on this intention to treat analysis, rATG use in the DCD LTx recipients appears safe and is not associated with increased infectious or hematologic complications. The significant reduction in infections in the rATG group may be related to differences in overall immunosuppression or an era effect. Additional studies are needed to better elucidate the etiology of reduced infection rates with rATG use in DCD LTx.

CITATION INFORMATION: Felix D., Geiger B., Descourouez J., Jorgenson M., Hanlon B., Leverson G., Foley D. Safety of Antithymocyte Globulin Use in Donation after Circulatory Death (DCD) Liver Transplantation Am J Transplant. 2017;17 (suppl 3).

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