Open AccessThe clinical significance of early histological rejection with or without biochemical abnormality in adult living donor liver transplantation for hepatitis B virus related end stage liver disease
Author(s) -
Cho Jai Young,
Suh KyungSuk,
Lee Hae Won,
Cho EungHo,
Yang Sung Hoon,
Cho Yong Beom,
Yi NamJoon,
Kim Min A,
Jang JaJune,
Lee Kuhn Uk
Publication year - 2007
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/j.1432-2277.2006.00384.x
Subject(s) - medicine , subclinical infection , odds ratio , abnormality , transplantation , liver transplantation , risk factor , gastroenterology , biopsy , population , confidence interval , stage (stratigraphy) , liver disease , surgery , psychiatry , biology , paleontology , environmental health
Summary There is no agreement regarding the treatment of early allograft rejection (EAR) in adult living donor liver transplantation (LDLT). A protocol biopsy was performed in 62 adult LDLT recipients. Twenty‐one patients (33.9%) had histological evidence of EAR. Of these, 14 patients had biochemical abnormalities and seven patients had no associated biochemical abnormalities. None of the seven patients with subclinical EAR (11.3% of the entire study population) were treated, and no subsequent rejection was observed. Gender mismatch (female‐to‐male) was the single independent risk factor for histological EAR [odds ratio (OR) = 13.458; 95% confidence interval (CI), 1.836–98.649] and the cumulative probability for a subsequent rejection was higher in patients with EAR (OR = 11.085; 95% CI, 1.221–100.654). However, the actuarial 1 year patient and graft survival rate in patients with EAR (81.0% and 85.5%) were similar to those without EAR (92.7% and 97.25%; P = 0.127 and 0.302, respectively). The presence of an initial biochemical abnormality was an independent risk factor for both a decreased patient survival (OR = 5.827; 95% CI, 1.095–31.017; P = 0.039) and graft loss (OR = 20.646; 95% CI, 2.044–208.524; P = 0.010). Subsequent rejection developed more frequently in patients with EAR. However, the survival is not determined by the presence of EAR but by the presence of a biochemical abnormality.