Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Fuehrlinger, K.
Single-center experience with low-dose anti-thymocyte globulin induction therapy in patients undergoing liver transplantation.
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2020. pp. 70
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Kniepeiss Daniela
- Pichlsberger Melanie
- Altmetrics:
- Abstract:
- Introduction: Thymoglobulin© induction therapy after liver transplantation is considered highly controversial. Studies about Thymoglobulin© induction therapy are rare. The aim of this study is to identify potential risk factors and patients who may profit from Thymoglobulin© induction therapy. Patients and Methods: Patients receiving primary liver transplants at the Clinical Department of Transplantation surgery of the University Hospital for Surgery, Graz between 01.01.2007 and 31.12.2018 (n=217) were included and patients with lack of data and/or additional kidney transplantation were excluded from analysis (n=6) defining Study Cohort 1 (n=211). Study Cohort 1 was used to determine independent influences of Thymoglobulin© induction on patient survival, graft survival, rejection-free graft survival, cancer-free survival as well as CMV infections, bronchopulmonary and/ or urinary tract infections within the first month deploying multivariable Cox regression and logistic regression modelling, respectively. Further exclusion of patients with lack of follow-up data on kidney function 6 months after transplantation (n=31) defined Study Cohort 2 (n=180) which was used to determine the influence of ATG on KDIGO-stage improvement 6 months after transplantation using multivariable logistic regression analysis. ROC-curve analysis (AUROC) was used to evaluate potential prognostic models. Results: Induction therapy with Thymoglobulin© did not influence patient survival, graft survival, rejection-free graft survival, and cancer-free survival significantly. Furthermore, Thymoglobulin© had no significant influence on non-viral infections within the first month after transplantation. Thymoglobulin© was revealed as an independently significant risk factor for CMV-PCR positivity within the first month and within the first 6 months after transplantation. Furthermore, CMV-PCR positive events within the first month after transplantation demonstrated a significant influence on patient survival. Thymoglobulin© and a recipients BMI > 25 kg/m2 independently and significantly influenced the KDIGO stage of kidney function at 6 months after transplantation suggesting a potentially useful predictive model (AUROC = 0,916). Discussion: Patients with compromised pre-transplant renal function with higher KDIGO stages and a BMI ≤ 25 kg/m2 profit most from Thymoglobulin© induction therapy resulting in the improvement of kidney function 6 months after transplantation. Patients with Thymoglobulin© induction therapy should receive CMV-prophylaxis due to the increased associated risk for early CMV-PCR positive events.