SHORT-TERM, LOW-DOSE THYMOGLOBULINE: THE BEST OPTION TO SPARE CALCINEURIN INHIBITORS IN LIVER TRANSPLANT RECIPIENTS WITH RENAL FAILURE?

IMMUNOSUPPRESSION FOR LIVER TRANSPLANTATION

P.C. Casciato¹, S. Marciano², O.A. Galdame², A.G. Villamil³, J.C. Bandi³, E. De santibañes⁴, A.C. Gadano^3
1Transplant Unit, Hospital Italiano Buenos Aires, Buenos Aires/ARGENTINA, ²Liver Transplantation Unit, Hospital Italiano, Buenos Aires/ARGENTINA, ³, Liver Transplantation Unit, Buenos Aires/ARGENTINA, ⁴Liver Transplantation Unit, hospital italiano, Buenos Aires/ARGENTINA

Body: Different strategies have been investigated to reduce calcineurin inhibitor (CI) exposure following liver transplantation (LT), particularly in patients with renal failure. We aimed to evaluate the efficacy and safety of three CI-sparing strategies, in liver transplant recipients with renal failure. Methods: Cirrhotic patients with renal failure at the time of liver transplantation were randomized in three groups according to the CI sparing strategy adopted. Group I: Induction with thymoglobuline at a dose of 1.5 mg/kg for 7 days (Thymo); Group II: Induction with thymoglobuline at a dose of 1.5 mg/kg for 3 days (Low Thymo); Group III: Induction with Anti CD-25 antibodies (Basiliximab) at a dose of 20 mg at days 1 and 4 (Anti CD 25). Basal creatinine clearance (mL/min/1.73m²±SD) was 37±13, 44±12 and 44±15 for Groups I, II and III, respectively (ns). Baseline clinical characteristics (age, sex, Child-Pugh Score, MELD Score, aetiology of cirrhosis and type of CI) did not differ among the three groups. The primary endpoint was acute rejection during the first year after LT. Secondary endpoints were graft survival, infections and outcome of renal function. Results:

Follow Up (12 months)	Regular Thymo n=17	Low Thymo n=14	Anti CD 25 n=14
Acute Rejection, n (%)	4 (23)	3 (21)	6 (43)*
Patient Survival, n (%)	15 (88)	11 (79)	12 (85)
Day of CI onset	8,2±3,1	5,3±2,4	2,8±1,1
D 14 Cr Cl (mL/min/1.73m2±SD)	69±19	65±23	51±21*
Bacterial Infections, n (%)	5 (29)	3 (21)	2 (14)
CMV Infections, n (%)	5 (29)*	2 (14)	2 (14)

*p<0.05 Conclusion: In liver transplant patients with renal failure at the time of the procedure, a 3 days induction regimen with low dose thymoglobuline, allows to spare CI, resulting in an improvement of renal function with a low rejection and infection rate.

Disclosure: All authors have declared no conflicts of interest.