Interleukin-2 receptor antibody for immunosuppressive induction therapy after liver transplantation in patients with chronic hepatitis B infection

Abstract

Background We hypothesize that the use of interleukin-2 (IL-2) receptor antibody in the induction therapy with early elimination of steroid is beneficial to patients with chronic hepatitis B disease undergoing liver transplantation. Patients and Methods We prospectively evaluate a series of 24 patients with chronic hepatitis B infection who underwent live-donor (n = 14) or cadaveric (n = 10) liver transplantation. Six patients had co-existing hepatocellular carcinoma. IL-2 receptor antibody (basiliximab 20mg, n = 7; or daclizumab 1mg/kg, n = 17) was prescribed within 6 hours of graft reperfusion and postoperative day 4 (IL-2 group). Methylprednisolone injection was given intraoperatively (1g) and on postoperative day 1 (500mg). Postoperative immunosuppression was maintained with oral tacrolimus (trough level of 5 to 10ng/ ml) and mycophenolate mofetil (750mg twice daily) without the use of steroid. Oral lamividine 100mg daily was used for hepatitis B prophylaxis. The operative outcomes were compared with 32 patients who received standard immunosuppressive regimen consisting of tacrolimus and corticosteroid (steroid group). Results There was a trend towards lower incidences of postoperative hypertension and diabetes in the IL-2 group compared with the steroid group (0% vs 16%, p = 0.072; 6% vs 31%, p = 0.065, respectively). The median postoperative hospital stay was 15 days in the IL-2 group, and that of the steroid group of patients was 21 days (p = 0.123). With a median followup of 5.8 months, 4 (17%) patients in the IL-2 group had acute cellular rejection and required steroid treatment. The incidence was not different from that of the steroid group (28%, p = 0.358). None of the patients in the IL-2 group had hepatitis B viral breakthrough, while one patient in the steroid group had the complication and required treatment with adefovir. Conclusions Treatment of liver transplant recipients who had underlying chronic hepatitis B with IL-2 receptor antibody and early withdrawal of steroid is associated with a trend towards lower incidences of postoperative diabetes and hypertension, without increase in the incidence of acute cellular rejection. Longterm follow-up is required to document the potential benefits on hepatitis B and liver tumor recurrence.