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Revisiting chronic rejection following living donor liver transplantation in the tacrolimus era: A single center experience
Author(s) -
Choudhary Narendra Singh,
Saraf Neeraj,
Saigal Sanjiv,
Gautam Dheeraj,
Rastogi Amit,
Goja Sanjay,
Bhangui Prashant,
Srinivasan Thiagrajan,
Yadav Sanjay Kumar,
Soin Arvinder
Publication year - 2018
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.13161
Subject(s) - medicine , immunosuppression , everolimus , tacrolimus , sirolimus , interquartile range , liver transplantation , incidence (geometry) , gastroenterology , transplantation , single center , calcineurin , surgery , azathioprine , physics , disease , optics
Background and Aims Chronic rejection ( CR ) is an uncommon but important cause of graft dysfunction, leading to graft loss and often requires retransplantation. This study evaluates the incidence and outcome of the patients with CR at a large living donor liver transplant ( LDLT ) center. Methods Data of patients with CR were retrospectively analyzed in 1232 adult (age >18 years) LDLT on tacrolimus (mainly)‐based immunosuppression. Sirolimus/everolimus (mammalian target of rapamycin [ mTOR ] inhibitors) was added to baseline immunosuppression as rescue therapy in patients with CR . Data are shown as median ( interquartile range [IQR] ). Results Twenty‐three patients (22 males), aged 42 ( IQR 45‐56) years, had biopsy‐proven chronic rejection at 21 (8‐44) months after liver transplantation. The incidence of chronic rejection was 1.9% in this cohort. The patients with CR (n = 23) had a significantly higher incidence of cytomegalovirus ( CMV ) viremia, acute cellular rejection, and history of anastomotic biliary strictures as compared to patients without CR . Five patients were noncompliant with immunosuppression before the diagnosis of CR . Twelve patients (52%) responded to addition of mTOR inhibitors, whereas 11 did not respond and had poor outcome. Conclusion The incidence of chronic rejection is low in LDLT . Treatment with mTOR inhibitors can reverse graft dysfunction in approximately half of the patients.