Anti-thymocyte Globulin for the Treatment of Acute Cellular Rejection Following Liver Transplantation

Schmitt, Timothy M.; Phillips, Melissa S.; Sawyer, Robert G.; Hagspiel, Klaus D.; Pruett, Timothy L.; Bonatti, Hugo

doi:10.1007/s10620-010-1149-x

Cited by 45 publications

(42 citation statements)

References 35 publications

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“…Following the promising results from renal transplantation, the polyclonal antibody, ATG was used for the treatment of SRR in most LT centers. The results have been promising with most cases of SRR responding to ATG [27,28] . For treatment of rejection, ATG is usually started with a dose of 1.5 mg/kg per day intravenously.…”

Section: Monitoring Of the Immune Statusmentioning

confidence: 99%

“…Variable between centers, a single dose of 30 mg may be used in operating room ATG (Thymoglobulin ® , ATGAM ® ) [27][28][29][30] T cell depleting polyclonal antibody Induction of immunosuppression, treatment of steroid resistant rejection Variable between centers, For induction 1.5 mg/ kg per day iv for 3 d and for treatment of rejection 1.5 mg/kg per day iv for 5-7 d of thymoglobulin may be used. For ATGAM a higher dose of 15 mg/kg per day is usually used 2 Daclizumab (Zenapax ® ) [23,115] IL-2Ra, monoclonal antibody…”

Section: Induction Of Immunosuppressionmentioning

confidence: 99%

“…Equine ATG (eATG, ATGAM ® ) is of equine origin and rabbit ATG (rATG, Thymoglobulin ® ) is generated in rabbits. ATG has been widely used for the treatment of steroid resistance rejections [27,28] as well as induction of immunosuppression in LT [29,30] . rATG is one of most commonly used agents for antibody induction therapy in organ transplantation in the United States.…”

Section: This Group Includesmentioning

confidence: 99%

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Review on immunosuppression in liver transplantation

Moini

Schilsky

Tichy

2015

WJH

200

159

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Section: Monitoring Of the Immune Statusmentioning

confidence: 99%

Section: Induction Of Immunosuppressionmentioning

confidence: 99%

Section: This Group Includesmentioning

confidence: 99%

See 1 more Smart Citation

Review on immunosuppression in liver transplantation

Moini

Schilsky

Tichy

2015

WJH

200

159

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“…[3][4][5] However, it has also been shown that the use of rabbit antithymocyte globulin (rATG) as induction therapy or therapy of steroid-resistant ACR is associated with increased risk of aggressive HCV recurrence. [6][7][8] Since 2000, our standard antibody induction protocol has included an interleukin 2 receptor (IL-2R) antibody. In the face of the increasing Model for EndStage Liver Disease (MELD) scores of our recipient population and the use of more expanded criteria deceased donors, in 2005, rATG was introduced as an alternative agent as a way to spare the kidney, with a later introduction of calcineurin drugs and minimized immunosuppressive load in the short and long term.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Montenovo

Jalikis²,

Li³

et al. 2017

Exp Clin Transplant

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Objectives: The use of induction therapy in liver transplant is debatable. We aimed to compare clinical outcomes of different induction protocols in liver transplant recipients. Materials and Methods: This was a retrospective cohort analyses using the University of Washington Transplant Database from January 2005 to May 2012 for adult (≥ 18 y old) primary liver transplant patients. All patients received induction therapy. Maintenance immuno suppressive agents were tacrolimus or tacrolimus-mycophenolate mofetil. Primary endpoints were acute cellular rejection, patient survival, and graft survival. In patients with chronic hepatitis C, the degree of histologic inflammation or fibrosis at 1 year was assessed. Cox proportional hazards models were constructed to evaluate variables associated with both patient and graft survival. Results: We identified 595 patients: 322 patients received rabbit antithymocyte globulin and 273 received interleukin 2 receptor blocker. Acute cellular rejection was higher in patients who received interleukin 2 receptor blocker than in patients who received rabbit antithymocyte globulin (27% vs 18%; P < .03). Both patient survival at 1 year (95% vs 90%), 3 years (92% vs 87%), and 5 years (86% vs 80%) and graft survival at 1 year (93% vs 88%), 3 years (90% vs 86%), and 5 years (83% vs 78%) were superior with rabbit antithymocyte globulin than with the interleukin 2 receptor blocker (P < .002). In patients with hepatitis C virus, type of induction therapy did not have any effect on the timing of hepatitis C virus recurrence. At 1 year after transplant, 33.3% in the rabbit antithymocyte globulin group had grade 3/4 inflammation and 10.2% had stage 3/4 fibrosis, compared with 16.8% and 4.8% in the interleukin 2 receptor blocker group (P ≤ .002 and not significant). Female recipient, Model for End-Stage Liver Disease score, hepatocellular carcinoma, and high preoperative serum creatinine levels were associated with less favorable patient and graft survival. Conclusions: Rabbit antithymocyte globulin is associated with lower rejection rate and improved patient and graft survival in liver transplant. Type of therapy affects the degree of histologic hepatitis C virus recurrence.

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“…1 g/gün, 3 gün boyunca) ve/veya antilemfosit ajanlar (ATG-ALG) kullanılır. Akut rejeksiyon nadiren retransplantasyon gerektirebilir (58,(145)(146)(147)(148).…”

Section: Rejeksiyonunclassified

Critical Care Management after Adult Liver Transplantation

Akan¹

2017

tybdd

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1ÖZ Karaciğer transplantasyonu uygulanan hastaların yoğun bakım yönetimi çok yönlü bir izlemi ve multidisipliner bir yaklaşımı gerektirir. Günümüzde ideal bir yoğun bakım tedavisi için deneyimli bir ekibe ve gelişmiş yoğun bakım/hastane olanaklarına gereksinim vardır. Karaciğer transplantasyon olgularının postoperatif yoğun bakım yönetimi zaman içinde hızlı bir gelişme göstermiştir. Preoperatif optimizasyon, cerrahi teknik, intraoperatif anestezi yönetimi, organ prezervasyonu, yoğun bakım ve immünosüpresyon tedavilerindeki gelişmeler ile 1998'de %79 düzeyinde olan karaciğer transplantasyonu sonrası bir yıllık sağkalım 2008'de %90'a yükselmiştir. Karaciğer transplantasyonlu olguların yoğun bakım yönetiminde özellikle hızlı kardiyorespiratuvar stabilizasyon, ağır koagülopatinin düzeltilmesi, mekanik ventilasyondan erken ayırma, uygun sıvı-elektrolit tedavisi, böbrek fonksiyonlarının korunması, greft rejeksiyonun önlenmesi ve enfeksiyon profilaksisi/tedavisi büyük önem taşır. Erken postoperatif dönem çok hassas bir süreç olduğundan yakın monitörizasyon, kardiyorespiratuvar fonksiyonların stabilizasyonu, greft fonksiyonunun sık değerlendirilmesi, komplikasyonların erken tanınması ve ekstrahepatik organ yetersizliklerinin hızlı tedavisi mortalite/morbiditenin azaltılabilmesi için zorunludur. Anahtar Kelimeler: Karaciğer transplantasyonu, postoperatif dönem, yoğun bakım, karaciğer yetersizliği ABSTRACT Critical care management after liver transplantation requires a sophisticated monitoring and multi-disciplinary team work. An experienced team and advanced critical care/hospital facilities are necessary for an ideal critical care treatment today. Critical care management after liver transplantation has shown a rapid development since the introduction of liver transplantation. While one-year survival rate after liver transplantation was 79% in 1998, it raised to 90% in 2008 related to the improvements in preoperative optimization, surgical technique, anesthetic management, organ preservation, critial care and immunosuppressive treatment. Treatment of severe coagulopathy, prompt hemodynamic and respiratory stabilization, early weaning from mechanical ventilation, proper fluid-electrolyte therapy, prevention of graft rejection, protection of renal functions and prophylaxis/treatment of infection are particularly important in critical care management after liver transplantation. As early postoperative period of liver transplantation is a critical phase; close monitoring, stabilization of cardiopulmonary functions, frequent evaluation of graft function, early diagnosis of complications and rapid treatment of extrahepatic organ failure are mandatory in order to reduce mortality/morbidity.

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Anti-thymocyte Globulin for the Treatment of Acute Cellular Rejection Following Liver Transplantation

Abstract: ATG effectively reversed severe and SSR; HCV recurrence and infections remain significant complications.

Cited by 45 publications

References 35 publications

Review on immunosuppression in liver transplantation

Review on immunosuppression in liver transplantation

Untitled

Critical Care Management after Adult Liver Transplantation

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