Table 3.
Ref. | Indication | Recipients | Regimens | Outcomes | Study duration | Rejection treatments protocols |
Belli et al[6] 2001 | HCV positive | Group A = 13 | RATG + AZA + CyA + ST (3 mo) | Acute rejection, chronic rejection, HCV recurrence | November 1997-November 1999 | NS |
Group B = 11 | /RATG + AZA + CyA | |||||
Group C = 13 | /RATG + AZA + CyA + ribavirin | |||||
Boillot et al[7] 2005 | Adult patients undergoing first OLT | Group A = 351 (103) | TACRO + daclizumab/TACRO + ST (3 mo) | Acute rejection, corticosteroid resistant acute rejection, graft survival | July 2000-February 2002 | Increasing TACRO dose and/or steroids |
Group B = 347 (106) | ||||||
Eason et al[10] 2003 | Adult patients undergoing first OLT | Group A = 59 (34) | RATG + TACRO + MMF/ST (3 mo) + TACRO + MMF | Patient survival, graft survival, rejection, adverse events, HCV recurrence | December 1999-August 2002 | Increasing TACRO or adding MMF or sirolimus; steroids if no improvement after 48 h |
Group B = 60 (31) | ||||||
Filipponi et al[11] 2004 | HCV positive | Group A = 74 | Basiliximab + ST (3 mo) + CyA + AZA/basiliximab + CyA + AZA | HCV recurrence, patient survival, graft survival, treatment failure | October 1998-March 2001 | Methylprednisolone bolus for 3 d |
Group B = 66 | ||||||
Kato et al[14] 2007 | HCV positive | 1st Period Group A = 15 | 1st Period TACRO + daclizumab/TACRO + ST (3 mo)/2nd Period TACRO + daclizumab + MMF/TACRO + ST (3 mo) + MMF | Fibrosis stage, acute rejection, adverse events, predictors | November 1999-November 2001 | Methylprednisolone bolus ± taper; OKT3 for severe or treatment-resistant rejection |
Group B = 16/2nd Period Group A = 16 | ||||||
Group B = 23 | ||||||
Klintmalm et al[16] 2007 (updated by Klintmalm 2011) | HCV positive | Group A = 80 | TACRO + ST (3 mo)/TACRO + ST (3 mo) + MMF/daclizumab + TACRO + MMF | Risk factors, rejection, HCV recurrence, treatment failure | NS | Methylprednisolone bolus ± taper; mild rejection increasing tacrolimus ± antimetabolite (MMF or azathioprine) Antilymphocyte antibody for corticosteroid-resistant rejection |
Group B = 79 | ||||||
Group C = 153 | ||||||
Langrehr et al[18] 2002 | HCV positive | Group A = 27 | TACRO + ST (3 mo)/TACRO + MMF | Rejection, HCV recurrence | NS | NS |
Group B = 26 | ||||||
Lerut et al[19] 2004 (updated by Lerut 2008) | Adult patients undergoing first OLT | Group A = 50 | TACRO + ST (3 mo)/TACRO | Acute rejection, graft survival, adverse events | NS | NS |
Group B = 50 | ||||||
Lladó et al[22] 2006 (updated by Llado 2008) | Adult patients undergoing first OLT | Group A = 102 (45) | Basiliximab + CyA + ST (3 mo)/basiliximab + CyA | Acute rejection, patient survival, graft survival, infection | April 2001-September 2004 | Methylprednisolone bolus for 3 d ± taper ± increase in TACRO |
Group B = 96 (43) | ||||||
Lupo et al[17] 2005 (updated by Lupo 2008) | Adult patients undergoing first OLT | Group A = 20 (9) | CyA + ST (3 mo)/CyA + Basiliximab | Acute rejection | NS | Methylprednisolone bolus for 3 d |
Group B = 21 (11) | ||||||
Margarit et al[25] 2005 | Adult patients undergoing first OLT | Group A = 28 (20) | TACRO/TACRO + ST (3 mo) | Acute rejection, severe acute rejection, HCV recurrence, 3 yr-graft survival | October 1998-September 2000 | Increasing tacrolimus dose; methylprednisolone bolus for 3 d ± taper for severe rejection |
Group B = 32 (15) | ||||||
Moench et al[26] 2007 (updated by Weiler 2010) | Adult patients undergoing first OLT | Group A = 56 (15) | TACRO/TACRO + ST (6 mo) | Patient survival, graft survival, acute rejection, chronic rejection, adverse events | February 2000-August 2004 | Methylprednisolone; tacrolimus adjusted higher level |
Group B = 54 (16) | ||||||
Nashan et al[27] 2001 | Adult patients undergoing first OLT | Group A = 25 (15) | Basiliximab + CyA + ST (3 mo)/Basiliximab + CyA + MMF | Rejection, HCV recurrence | January 1999-December 2000 | NS |
Group B = 26 (15) | ||||||
Pageaux et al[30] 2004 | Adult patients undergoing first OLT | Group A = 90 | Basiliximab + CyA + ST (6 mo)/basiliximab + CyA + placebo | Acute rejection, 6-mo graft and patient survival, treatment failure, recurrent HCV, adverse events | December 1999-August 2001 | NS |
Group B = 84 | ||||||
Pelletier et al[31] 2005 | Adult patients undergoing first OLT | Group A = 36 | TACRO + MMF + ST (3-6 mo) | Rejection, HCV recurrence, graft survival patient survival | June 2002- | Pulse steroids |
Group B = 36 | /TACRO + MMF | May 2004 | ||||
Reggiani et al[33] 2005 | Adult patients undergoing first OLT | Group A = 18 | TACRO + MMF + ST (3 mo)/TACRO + MMF | Acute rejection, adverse events, pharmacokinetics of MPA | NS | NS/increasing tacrolimus for mild rejection; methylprednisolone bolus 3 d ± taper for moderate rejection; OKT3 for steroid-resistant rejection |
Group B = 12 | ||||||
Samonakis et al[34] 2006 | HCV positive | Group A = 27 | TACRO/TACRO + ST (3-4 mo) + AZA | Acute rejection, survival, re-transplantation, adverse events | January 2000-January 2004 | Methylprednisolone bolus for 3 d |
Group B = 29 | ||||||
Studenik et al[35] 2005 | Adult patients undergoing first OLT | Group A = 19 | TACRO + daclizumab + ST (3 mo) + MMF/TACRO + daclizumab + MMF | Acute rejection | February 2003-November 2004 | NS |
Group B = 20 | ||||||
Tisone et al[37] 1999 | Adult patients undergoing first OLT | Group A = 22 | CyA + AZA + ST (3 mo)/CyA + AZA | Graft survival, adverse events, HCV recurrence | NS | Methylprednisolone bolus for 3 d only for severe rejection duct damage |
Group B = 23 | ||||||
Varo et al[38] 2005 (updated by Otero 2009) | Adult patients undergoing first OLT | Group A = 79 | TACRO + ST (3 mo)/TACRO + daclizumab + MMF | Acute rejection | NS | Up to 3 full courses of high dose steroids |
Group B = 78 | ||||||
Washburn et al[39] 2001 | Adult patients undergoing first OLT | Group A = 15 | TACRO + MMF + ST (15 mo)/daclizumab + TACRO + MMF | Adverse events, rejection | April 1999-October 1999 | Increasing tacrolimus dose; steroid bolus for moderate rejection |
Group B = 15 | ||||||
Manousou et al[24] 2009 | HCV positive | Group A = 54 | TACRO/TACRO + AZA + ST (3 mo) | Progression to Ishak S4, graft failure resulting in retransplantation or patient death, immunological failure, patient survival, acute rejection, chronic rejection, steroid-resistant rejection, recurrent HCV | January 2000-June 2007 | Pulse steroids |
Group B = 49 | ||||||
Ramirez et al[32] 2013 | Adult patients undergoing first OLT | Group A = 20 | Basiliximab + TACRO + EC-MPS + ST (6 mo)/basiliximab + TACRO + EC-MPS | Patient survival, graft survival, rejection, adverse events | February 2006-November 2007 | NS |
Group B = 19 | ||||||
Neumann et al[28] 2012 | HCV positive | Group A = 67 | TACRO + ST (3 mo)/TACRO + DAC | Viral load of HCV at 12 mo, the incidence of BPAR, patient and graft survival at 12 mo, renal function, adverse events | June 2005- Jun 2008 | Increasing tacrolimus dose to trough levels of 15 ng/mL ± pulses of corticosteroids up to 1000 mg/d for 3 consecutive days |
Group B = 68 | ||||||
Takada et al[36] 2013 | Living donor liver transplantation HCV positive | Group A = 35 | TACRO + ST (3 mo) /TACRO + MMF | Event-free survival: histological recurrence of hepatitis C, BPAR resistant to 2 sets of steroid pulse therapy, hepatocellular carcinoma recurrence, Re-transplantation, Patient death | NS | Pulse steroids |
Group B = 40 | ||||||
Lerut et al[19] 2008 | Adult patients undergoing first OLT | Group A = 78 | TACRO + ST (64 d)/TACRO | Graft and patient survival, incidences of TAC monotherapy and of low-dosage TAC monotherapy, renal insufficiency, diabetes mellitus, hypercholesterolemia, hyperuricemia, arterial hypertension, infectious, tumor complications, and performance status | February 2000-September 2004 | Corticosteroid-sensitive rejection was treated with 3 to 5 oral or IV boluses of 200-mg Methylprednisolone. CRC was treated with a 10-d IV course of muromonab orthoclone OKT3 |
Group B = 78 | ||||||
Becker et al[5] 2008 | Adult patients undergoing first OLT or split liver allograft transplantation | Group A = 305 | TACRO + daclizumab/TACRO + MMF | Rejection, overall survival and allograft survival, renal function | March 2005-June 2007 | NS |
Group B = 297 | ||||||
Cholongitas et al[9] 2011 | Chronic liver disease | Group A = 36 | CyA/TACRO | Death | January 1996-January 1997 | Acute rejection was treated with three 1 g/d methylprednisolone |
Group B = 30 | ||||||
Gerhardt et al[12] 2009 | Adult patients undergoing first OLT | Group A = 8 | CNI/MMF vs a MMF/prednisone | Renal function | May 2003- May 2005 | ‘‘mild’’ rejection episodes were treated with steroid boluses Steroid pulse therapy |
Group B = 13 | ||||||
Klintmalm et al[15] 2011 | HCV positive | Group A = 77 | TACRO + ST (3 mo)/TACRO + ST (3 mo) + MMF/daclizumab + TACRO + MMF | Acute rejection, HCV recurrence, survival | NS | ACR was treated with an increase in TACRO to 15 ng/mL without a corticosteroid bolus and recycle. Moderate to severe ACR 4) was treated with a 1.0-g bolus of methylprednisolone, followed by a 6-d steroid taper of intravenous methylprednisolone or oral prednisone |
Group B = 72 | ||||||
Group C = 146 | ||||||
Lladó et al[21] 2008 | HCV positive | Group A = 46 | Basiliximab + CyA + ST (3 mo)/basiliximab + CyA | Acute rejection, patient and graft survival, adverse events (infections and metabolic decompensations), HCV recurrence | April 2001-September 2004 | Methylprednisolone bolus for 3 d ± taper ± increase in TACRO |
Group B = 43 | ||||||
Lupo et al[23] 2008 | Adult patients undergoing first OLT | Group A = 21 | CyA + ST (3 mo)/CyA + Basiliximab | Acute rejection, patient and graft survival, HCV recurrence, medical and surgical complications, infections | November 2002-November 2005 | Methylprednisolone bolus for 3 d |
Group B = 26 | ||||||
Otero et al[29] 2009 | Adult patients undergoing first OLT | Group A = 79 | TACRO + ST (3 mo)/TACRO + Daclizumab + MMF | Acute rejection, time to rejection, patient and graft survival, HCV status, hepatic and renal function | May 2002-December 2003 | Up to 2 courses of high dose steroids for 3 d Corticosteroid-resistant rejection episode was treated with anti-lymphocyte therapy |
Group B = 78 | ||||||
Weiler et al[40] 2010 | Adult patients undergoing first OLT | Group A = 56 | All patients TACRO + steroids for the first 2 wk TACRO/TACRO + ST (6 mo) | Patient survival, organ survival, steroid side-effects, acute rejection, chronic rejection, HCV recurrence | February 2000-August 2004 | Methylprednisolone; tacrolimus adjusted higher level |
Group B = 54 | ||||||
Junge et al[13] 2005 | Recipients with autoimmune hepatitis | Group A = 14 | TACRO + steroids/TACRO + MMF | Graft and patient survival, acute rejection, liver functions, glucose metabolism, bone density, blood pressure, renal function, drug-related side-effects, infections | NS | Mild or moderate rejection: methylprednisolone pulse therapy severe rejection: high-dose steroids + monoclonal antibody |
Group B = 16 | ||||||
Bonaccorsi-Riani et al[8] 2012 | HCV positive | Group A = 14 | TACRO + steroids (2 mo)/TACRO + placebo | 1 and 5 yr survival; HCV recurrence, retransplantation, death | NS | NS |
Group B = 21 |
Numbers within brackets in the third column show the number of hepatitis C virus (HCV) transplanted patients; CyA: Cyclosporine; TACRO: Tacrolimus; ST: Steroids; RATG: Rabbit antithymocyte globulin; AZA: Azathioprine; MMF: Mycophenolate mofetil; OKT3: Murine monoclonal IgG2a antibody; EC-MPS: Enteric-coated mycophenolate sodium; BPAR: Biopsy-proven acute rejection; S4: Stage 4; CRC: Corticosteroid-resistant rejection; OLT: Orthotopic liver transplantation; BPAR: Biopsy proven acute rejection; NS: Non-significance.