Steroid minimization immunosuppression protocol using basiliximab in adult living donor liver transplantation for hepatitis C virus-related cirrhosis

Taizo Hibi, Masahiro Shinoda, Osamu Itano, Hideaki Obara, Minoru Kitago, Yuta Abe, Hiroshi Yagi, Masayuki Tanaka, Ken Hoshino, Akihiro Fujino, Tatsuo Kuroda, Shigeyuki Kawachi, Minoru Tanabe, Motohide Shimazu, Yuukou Kitagawa

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aim: Recent randomized trials have failed to prove the benefit of steroid-free immunosuppression in liver transplantation for hepatitis C virus (HCV)-related cirrhosis. Furthermore, there is a lack of data on the use of basiliximab in living donor liver transplantation (LDLT). This pilot study evaluated the safety and efficacy of a steroid minimization protocol using basiliximab compared with standard immunosuppression. Methods: A single center, prospective cohort analysis was conducted to compare two immunosuppression regimens in adult recipients who underwent LDLT for HCV since 2004: calcineurin inhibitor/mizoribine/basiliximab (the St- group) and calcineurin inhibitor/mizoribine/steroid (the St+ group). Study end-points were rejection rates, recurrent HCV, patient survival and other adverse events up to 2years after transplantation. Results: A total of 27 consecutive patients were enrolled. Transplantation characteristics were similar between the two groups (14 St- and 13 St+) except ABO incompatible cases being more common in the St+ group. Rejection rates, recurrent HCV, patient survival, fibrosis stage and new-onset diabetes mellitus at 2years were comparable between the two groups. ABO incompatibility did not affect short- and long-term outcomes. Nine St- and seven St+ recipients underwent interferon and ribavirin therapy for recurrent HCV, with a sustained virological response rate of 33% and 29%, respectively. Conclusion: A steroid minimization protocol with basiliximab in adult LDLT for HCV is safe and affords equivalent rejection rates compared with standard immunosuppression. However, no significant differences are observed with respect to recurrent HCV, patient survival and metabolic complications.

Original languageEnglish
JournalHepatology Research
DOIs
Publication statusAccepted/In press - 2015

Fingerprint

Living Donors
Hepacivirus
Liver Transplantation
Immunosuppression
Fibrosis
Steroids
Survival
Transplantation
Ribavirin
basiliximab
Interferons
Diabetes Mellitus
Cohort Studies
Safety

Keywords

  • Basiliximab
  • Hepatitis C virus
  • Immunosuppression
  • Liver transplantation
  • Living donors
  • Steroids

ASJC Scopus subject areas

  • Hepatology
  • Infectious Diseases

Cite this

Steroid minimization immunosuppression protocol using basiliximab in adult living donor liver transplantation for hepatitis C virus-related cirrhosis. / Hibi, Taizo; Shinoda, Masahiro; Itano, Osamu; Obara, Hideaki; Kitago, Minoru; Abe, Yuta; Yagi, Hiroshi; Tanaka, Masayuki; Hoshino, Ken; Fujino, Akihiro; Kuroda, Tatsuo; Kawachi, Shigeyuki; Tanabe, Minoru; Shimazu, Motohide; Kitagawa, Yuukou.

In: Hepatology Research, 2015.

Research output: Contribution to journalArticle

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title = "Steroid minimization immunosuppression protocol using basiliximab in adult living donor liver transplantation for hepatitis C virus-related cirrhosis",
abstract = "Aim: Recent randomized trials have failed to prove the benefit of steroid-free immunosuppression in liver transplantation for hepatitis C virus (HCV)-related cirrhosis. Furthermore, there is a lack of data on the use of basiliximab in living donor liver transplantation (LDLT). This pilot study evaluated the safety and efficacy of a steroid minimization protocol using basiliximab compared with standard immunosuppression. Methods: A single center, prospective cohort analysis was conducted to compare two immunosuppression regimens in adult recipients who underwent LDLT for HCV since 2004: calcineurin inhibitor/mizoribine/basiliximab (the St- group) and calcineurin inhibitor/mizoribine/steroid (the St+ group). Study end-points were rejection rates, recurrent HCV, patient survival and other adverse events up to 2years after transplantation. Results: A total of 27 consecutive patients were enrolled. Transplantation characteristics were similar between the two groups (14 St- and 13 St+) except ABO incompatible cases being more common in the St+ group. Rejection rates, recurrent HCV, patient survival, fibrosis stage and new-onset diabetes mellitus at 2years were comparable between the two groups. ABO incompatibility did not affect short- and long-term outcomes. Nine St- and seven St+ recipients underwent interferon and ribavirin therapy for recurrent HCV, with a sustained virological response rate of 33{\%} and 29{\%}, respectively. Conclusion: A steroid minimization protocol with basiliximab in adult LDLT for HCV is safe and affords equivalent rejection rates compared with standard immunosuppression. However, no significant differences are observed with respect to recurrent HCV, patient survival and metabolic complications.",
keywords = "Basiliximab, Hepatitis C virus, Immunosuppression, Liver transplantation, Living donors, Steroids",
author = "Taizo Hibi and Masahiro Shinoda and Osamu Itano and Hideaki Obara and Minoru Kitago and Yuta Abe and Hiroshi Yagi and Masayuki Tanaka and Ken Hoshino and Akihiro Fujino and Tatsuo Kuroda and Shigeyuki Kawachi and Minoru Tanabe and Motohide Shimazu and Yuukou Kitagawa",
year = "2015",
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T1 - Steroid minimization immunosuppression protocol using basiliximab in adult living donor liver transplantation for hepatitis C virus-related cirrhosis

AU - Hibi, Taizo

AU - Shinoda, Masahiro

AU - Itano, Osamu

AU - Obara, Hideaki

AU - Kitago, Minoru

AU - Abe, Yuta

AU - Yagi, Hiroshi

AU - Tanaka, Masayuki

AU - Hoshino, Ken

AU - Fujino, Akihiro

AU - Kuroda, Tatsuo

AU - Kawachi, Shigeyuki

AU - Tanabe, Minoru

AU - Shimazu, Motohide

AU - Kitagawa, Yuukou

PY - 2015

Y1 - 2015

N2 - Aim: Recent randomized trials have failed to prove the benefit of steroid-free immunosuppression in liver transplantation for hepatitis C virus (HCV)-related cirrhosis. Furthermore, there is a lack of data on the use of basiliximab in living donor liver transplantation (LDLT). This pilot study evaluated the safety and efficacy of a steroid minimization protocol using basiliximab compared with standard immunosuppression. Methods: A single center, prospective cohort analysis was conducted to compare two immunosuppression regimens in adult recipients who underwent LDLT for HCV since 2004: calcineurin inhibitor/mizoribine/basiliximab (the St- group) and calcineurin inhibitor/mizoribine/steroid (the St+ group). Study end-points were rejection rates, recurrent HCV, patient survival and other adverse events up to 2years after transplantation. Results: A total of 27 consecutive patients were enrolled. Transplantation characteristics were similar between the two groups (14 St- and 13 St+) except ABO incompatible cases being more common in the St+ group. Rejection rates, recurrent HCV, patient survival, fibrosis stage and new-onset diabetes mellitus at 2years were comparable between the two groups. ABO incompatibility did not affect short- and long-term outcomes. Nine St- and seven St+ recipients underwent interferon and ribavirin therapy for recurrent HCV, with a sustained virological response rate of 33% and 29%, respectively. Conclusion: A steroid minimization protocol with basiliximab in adult LDLT for HCV is safe and affords equivalent rejection rates compared with standard immunosuppression. However, no significant differences are observed with respect to recurrent HCV, patient survival and metabolic complications.

AB - Aim: Recent randomized trials have failed to prove the benefit of steroid-free immunosuppression in liver transplantation for hepatitis C virus (HCV)-related cirrhosis. Furthermore, there is a lack of data on the use of basiliximab in living donor liver transplantation (LDLT). This pilot study evaluated the safety and efficacy of a steroid minimization protocol using basiliximab compared with standard immunosuppression. Methods: A single center, prospective cohort analysis was conducted to compare two immunosuppression regimens in adult recipients who underwent LDLT for HCV since 2004: calcineurin inhibitor/mizoribine/basiliximab (the St- group) and calcineurin inhibitor/mizoribine/steroid (the St+ group). Study end-points were rejection rates, recurrent HCV, patient survival and other adverse events up to 2years after transplantation. Results: A total of 27 consecutive patients were enrolled. Transplantation characteristics were similar between the two groups (14 St- and 13 St+) except ABO incompatible cases being more common in the St+ group. Rejection rates, recurrent HCV, patient survival, fibrosis stage and new-onset diabetes mellitus at 2years were comparable between the two groups. ABO incompatibility did not affect short- and long-term outcomes. Nine St- and seven St+ recipients underwent interferon and ribavirin therapy for recurrent HCV, with a sustained virological response rate of 33% and 29%, respectively. Conclusion: A steroid minimization protocol with basiliximab in adult LDLT for HCV is safe and affords equivalent rejection rates compared with standard immunosuppression. However, no significant differences are observed with respect to recurrent HCV, patient survival and metabolic complications.

KW - Basiliximab

KW - Hepatitis C virus

KW - Immunosuppression

KW - Liver transplantation

KW - Living donors

KW - Steroids

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DO - 10.1111/hepr.12486

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