Premium
Risk factors for acute liver allograft rejection and their influences on treatment outcomes of rescue therapy in living donor liver transplantation
Author(s) -
Shindoh Junichi,
Akamatsu Nobuhisa,
Tanaka Tomohiro,
Kaneko Junichi,
Tamura Sumihito,
Sakamoto Yoshihiro,
Hasegawa Kiyoshi,
Sugawara Yasuhiko,
Makuuchi Masatoshi,
Kokudo Norihiro
Publication year - 2016
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12760
Subject(s) - medicine , liver transplantation , transplantation , odds ratio , gastroenterology , multivariate analysis , liver disease , prospective cohort study , immunology , surgery
Background Several clinical factors are reportedly correlated with acute cellular rejection (ACR) after liver transplantation. However, the factors that determine the response to rescue therapies remain unclear. Methods A prospective database of 413 consecutive adult patients who underwent living donor liver transplantation (LDLT) was reviewed. Results Ninety‐nine (24%) patients developed ACR after LDLT. A multivariate analysis revealed that a positive T‐lymphocytotoxic test (odds ratio [OR], 3.85; P =.017), HLA‐DR mismatch (OR, 2.99; P =.013), autoimmune disease (OR, 2.61; P =.001), and a younger recipient age (OR, 0.60 for +10 years; P <.001) were independent risk factors for ACR. Among these, autoimmune disease was significantly correlated with refractoriness to the standard rescue therapy (53% vs 30%, P =.02) and relapse of cellular rejection (34% vs 16%, P =.04). After rescue therapy, 98 of the 99 (99%) patients eventually recovered from ACR and graft loss was observed in only one patient. None of the risk factors for ACR impaired both graft survival and overall survival after LDLT. Conclusions Autoimmune liver disease is associated with refractoriness to rescue therapy for ACR and the relapse of rejection. However, ACR does not affect the long‐term outcomes of LDLT if it is well controlled.