2005 Abstracts: Ninety Five Cases of Liver Transplantation Using Campath-1H Induction Immunosuppression
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Ninety Five Cases of Liver Transplantation Using Campath-1H Induction Immunosuppression
Panagiotis Tryphonopoulos, David M. Levi, Juan R. Madariaga, Seigo Nishida, Tomoaki Kato, Jang Moon, Genarro Selvaggi, Debbie Weppler, Phillip Ruiz, Andreas G. Tzakis, University of Miami, Miami, FL
Introduction: We present our experience with 95 cases of liver transplantation, using Campath-1H induction immunosuppression.
Materials and methods: From December 2001 until September 2004, we administered C1H induction immunosuppression with low dose Tacrolimus (Tac) maintenance immunosuppression to 95 adult recipients of an isolate liver allograft. Patients with Hepatitis C, Hepatitis B (DNA +), patients with more than one organ transplant, fulminant hepatic failure or unconventional surgical transplant techniques were excluded from this study. Until April 2004, patients, (n=82), got 4 doses of C1H (0.3 mg/kg IV), just before and at the end of the transplant procedure and on post-operative days 3 and 7. Patients that were transplanted after May 2004 (n=13), received only 2 doses of C1H, (30 mg/dose IV), at the end of the transplant procedure and on post-operative day 4. Tacrolimus was administered with 12 hour trough levels aimed at 5-10 ng/ml. Results: Patient and graft survival was 95% and 90.7% respectively at 3 years. There was no significant difference in the severity of the rejection episodes compared to our previous experience. However, the percentage of patients that experienced biopsy proven acute rejection was significantly lower in the C1H group (19% vs. 36% in our historical controls, at 18 months, p=.006). The mean Tacrolimus 12 hour trough levels were significantly lower than our previous experience throughout the study (about 6 ng/ml). Similarly, the mean Tacrolimus doses were alsolower compared to our previous experience. This fact contributed to a consistently lower serum creatinine level and less incidence of calcineurin-inhibitor nephrotoxicity. Conversion from tacrolimus to other regimens due to nephrotoxicity occurred within 6 months post transplantation and was 3% versus 26% from our previous experience. There was no significant difference in the opportunistic infections compared to our previous experience. Patients that received C1Hbefore the transplant procedure, received intraoperatively a significantly higher amount of packed red blood cells, platelets, fresh frozen plasma and cryoprecipitatethan the historical controls. Conclusions: C1H induction immunosuppression is an effective regimen in liver transplantation, associated with a lower incidence of acute rejection, lower tacrolimus trough levels and less immunosuppression related nephrotoxicity.
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