Interleukin-2 receptor antibody (basiliximab) for immunosuppressive induction therapy after liver transplantation: A protocol with early elimination of steroids and reduction of tacrolimus dosage

✍ Scribed by Chi Leung Liu; Sheung Tat Fan; Chung Mau Lo; See Ching Chan; Irene O. Ng; Ching Lung Lai; John Wong

• Publisher: John Wiley and Sons
• Year: 2004
• Tongue: English
• Weight: 82 KB
• Volume: 10
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20144

✦ Synopsis

A prospective evaluation was performed to study the potential benefits of the use of interleukin-2 receptor antibody (IL-2Rab) in the induction therapy with early elimination of steroid and reduction of tacrolimus dosage in liver transplant recipients among whom 94% had chronic hepatitis B infection. Thirty-one liver transplant recipients who underwent right-lobe live donor (n ‫؍‬ 19) or cadaveric (n ‫؍‬ 12) liver transplantation received IL-2Rab, basiliximab 20 mg intravenously within 6 hours of graft reperfusion and on postoperative day 4 (IL-2ab group). Two doses of steroid injection were given intraoperatively and on postoperative day 1. Postoperative immunosuppression was maintained with oral tacrolimus and mycophenolate mofetil without the use of steroids. The operative outcomes were compared with those of 49 patients who received standard immunosuppressive regimen consisting of tacrolimus and corticosteroid (steroid group). The overall postoperative morbidity and hospital stay were comparable between the 2 groups. There were significantly lower incidences of postoperative new-onset diabetes (0% vs 28%, P ‫؍‬ .011), acute cellular rejection (6% vs 27%, P ‫؍‬ .038), and cytomegalovirus (CMV) antigenemia (0% vs 18%, P ‫؍‬ .011) in the IL-2Rab group compared with the steroid group. The blood cholesterol level at 6 months after transplantation was significantly lower in the IL-2Rab group (median, 4.0 vs 4.4 mmol/L, P ‫؍‬ .007). On follow-up, none of the patients in the IL-2Rab group had hepatitis B viral breakthrough or hepatocellu-lar carcinoma (HCC) recurrence, whereas 1 and 3 patients in the steroid group developed these complications, respectively. In conclusion, treatment of liver transplant recipients with IL-2Rab with early withdrawal of steroids and reduction of tacrolimus dosage is associated with lower incidences of postoperative new-onset diabetes, acute cellular rejection, and CMV antigenemia, as well as a lower serum cholesterol level. Further studies and longterm follow-up are required to document their potential benefits on hepatitis B and HCC recurrences. (Liver Transpl 2004;10:728-733.)

C orticosteroids have long been a cornerstone of immunosuppression for liver transplant recipients. However, there are well-known side effects that result in significant morbidities, including hypertension, obesity, diabetes, hyperlipidemia, and infectious complications. Previous reports have shown that early reduction or elimination of corticosteroids could significantly reduce the incidence of many of these complications in liver transplant recipients. 1 -3 However, there is a significant risk of increased incidence of acute rejection associated with early steroid withdrawal that may require treatment with high doses of pulse steroids. With the advent of newer immunosuppressive agents, including tacrolimus, mycophenolate, interleukin-2 receptor antibody (IL-2Rab), or sirolimus, early steroid reduction or withdrawal in liver transplant recipients appears to be practical.

The liver is generally considered immunologically privileged, with low incidences of graft loss related to acute or chronic rejection. In addition, acute and chronic rejections have been reported to occur less frequently in hepatitis B -positive recipients. 4 However, recurrent hepatitis is frequently a major concern in liver transplant recipients with chronic hepatitis B infection. Corticosteroids are frequently implicated in the acceleration of a viral replication and recurrence after liver transplantation. 5,6 Despite the theoretical implication of upregulation of viral activity with corticosteroids, little has been published with regard to steroid avoid-