RESUMEN
Hepatitis C [HCV] is the most common indication for liver transplantation in the US. Since steroids are the major stimulus of viral replication, we postulated that steroid-free immunosuppression might be a safer approach. From January 1995 to October 2002, we used steroid plus calcineurin inhibitor [CNI] immunosuppression after liver transplantation for HCV [steroid group, n=81]. From October 2002 to June 2007, rabbit antithymocyte globulin [RATG] induction, followed by CNI and azathioprine [RATG group, n=73] was utilized. There were no differences in 1- and 3-year patient/allograft survival rates. The incidence of acute rejection rate [19% vs. 28%], of biopsy-proven HCV recurrence [70% vs. 75%], and chronic rejection [6% vs. 9%] were comparable. The mean time to develop recurrent HCV was significantly longer in the RATG group [16.2 vs. 9.2 months, p=0.008]. The incidence of severe portal fibrosis appears to be lower in RATG group compared to the steroid group; 14% vs. 4% [p=0.07]. RATG induction is safe and effective after liver transplantation for HCV, but has no impact on the incidence of HCV recurrence and patient/allograft survival. However, a significant delay in time to HCV recurrence and a trend toward less rejection and portal fibrosis was observed