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Genetic, immunological and clinical risk factors for biliary strictures following liver transplantation
Author(s) -
Iacob Speranta,
Cicinnati Vito R.,
Dechêne Alexander,
Lindemann Monika,
Heinemann Falko M.,
Rebmann Vera,
Ferencik Stanislav,
Sotiropoulos Georgios C.,
Popescu Irinel,
Horn Peter A.,
Gerken Guido,
Paul Andreas,
Beckebaum Susanne
Publication year - 2012
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2012.02810.x
Subject(s) - liver transplantation , medicine , abo blood group system , univariate analysis , immunology , gastroenterology , human leukocyte antigen , transplantation , antigen , multivariate analysis
Background Biliary strictures after liver transplantation ( LT ) are a major cause of morbidity and reduced graft survival. Aims The purpose of this study was to investigate genetic, immunological and clinical risk factors for the occurrence of post‐ LT ischaemic type biliary lesions ( ITBL s) and biliary anastomotic strictures ( AS ). Methods Clinical and laboratory data, chemokine receptor ( CCR ) genotypes, chemotactic cytokines and anti‐major‐histocompatibility complex antibodies in serum were investigated in 162 LT patients. Results In the univariate analysis, older donor and recipient age, partial LT , high peak aspartate aminotransaminase ( AST ) levels and CC chemokine receptor 5 delta32 loss‐of‐function mutation ( CCR 5Δ32) were associated with ITBL , whereas LT for acute liver failure ( ALF ), ABO ‐compatible non‐identical LT , presence of donor‐specific anti‐human leucocyte antigen ( HLA ) class II antibodies and fractalkine receptor ( CX 3 CR 1)‐249 II allele were associated with AS . In the multivariate analysis, CCR 5Δ32 was an independent risk factor for ITBL , whereas LT for ALF , ABO ‐compatible non‐identical LT , and CX 3 CR 1‐249 II allele remained predictive for AS . Serum levels of interferon‐gamma and interleukin ( IL )‐6 as well as IL ‐10 were significantly increased in patients with biliary strictures. Conclusion Specific chemokine receptor polymorphisms of the recipient are associated with development of post‐ LT biliary strictures. Altered cytokine profile may contribute to enhanced fibrotic tissue remodelling and biliary stricture formation. Screening of anti‐ HLA antibodies might be useful for early identification of at‐risk patients who could benefit from closer surveillance and tailored immunosuppressive regimen. Our findings may have relevance for prediction and management of post‐ LT biliary strictures.