Initial experience of combined immunosuppressive induction therapy with polyclonal antithymocyte antibody, FK 506 (tacrolimus), and prednisolone in clinical liver transplantation

Abstract

LIVER TRANSPLANTATION has become an accepted treatment modality for end-stage liver diseases such as chronic hepatitis C, posthepatitis, primary biliary, ethyl-toxic cirrhosis, primary sclerosing cholangitis, fulminant hepatic failure, Budd-Chiari syndrome, polycystic liver disease, and biliary atresia in infants. Results of liver transplantation improved dramatically with the introduction of the immunosuppressant cylosporine. Recently, newer immunosuppressive drugs such as polyclonal antilymphocyte antibodies (eg, ATG, ALG), tacrolimus (FK506), and mycophenolate mofetil (MMF) have been introduced to the field of human organ transplantation. Specifically, these drugs aim to confer satisfactory immunosuppression with fewer side effects. More selective regimes are anticipated with such drugs, together with a reduction in frequency and severity of rejection. Tacrolimus is being used more often as an alternative or replacement for induction, maintenance, and “rescue” therapy in acute graft rejection following liver transplantation. Currently, the ideal choice of immunosuppression induction in liver transplantation remains controversial. Although many multiand single-center trials have been conducted, questions remain unanswered. Such questions relate to the optimal time point of immunosuppression induction (before, during, after transplantation), and the choice of combination of immunosuppressive drugs, as well as their route of administration. At our institution, we have employed a novel combined regime for immunosuppression induction of polyglonal antithymocyte antibody (ATG), tacrolimus, and prednisolone in a prospective follow-up study in human orthotopic liver transplantation (OLT). We report our preliminary experience in 14 consecutive patients with a follow-up period of up to 19 months.