Comparison Of Quadruple Induction Including ATG Or IL-2 Receptor Antibody With FK506-Based Therapy After Liver Transplantation

Abstract

192 Today, orthotopic liver transplantation (OLT) has developed into a standard therapy for terminal liver failure. While cyclosporine (CyA)-based triple induction therapy is standard in many centers, the threat of rejection episodes still remains and has lead many investigators to study new immunosuppressive induction regimens. The present study compares our experience with two quadruple induction regimens [CyA plus prednisolone (Pred) and azathioprine (Aza) with either ATG or IL-2R antibody BT563] with FK506-based induction therapy. Between 7-90 and 6-94 428 OLT were performed at the Virchow Clinic. Excluding retransplantations and pediatric cases, 371 patients received a primary OLT. Of these 371 patients, 118 received quadruple immunosuppressive induction consisting of CyA, Pred, Aza and ATG, 144 received quadruple induction with a IL-2 receptor antibody (BT563) instead of ATG and to 109 patients FK506-based immunosuppression (FK506 plus Pred, or FK506 plus Pred plus Aza) was administered. Demographic data, such as sex, age and primary diagnosis were not significantly different between the groups. Actuarial patient survival according to the Kaplan-Meier method after 1 and 5 years showed 94% and 83% for the ATG-group, 88% and 83% for the BT-group and 91% and 80% for the FK506-group. Incidence of rejection and incidence of pneumonias and CMV-infections as examples for serious infectious complications are depicted in the table below.These data demonstrate that quadruple regimens with either ATG or BT563 and FK506-based induction regimens yield excellent 5-year patient and graft survival. Furthermore, the quadruple induction with BT563 showed a lower incidence of rejection and the FK-based therapy resulted in less CMV-infections. These results may help to select an individual induction therapy following OLT.