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Late acute rejection after liver transplantation impacts patient survival.

Abstract：

:Hepatic allograft rejection still remains an important problem following liver transplantation. Early acute rejection, occurring within three months of transplant, is a common event and usually of lesser significance with respect to prognosis than other non-immune-related post-transplant morbidities. However, little is known about late acute rejection (LAR) including factors affecting its occurrence and long-term outcome. In this study, we analyzed LAR including the incidence, clinical risk factors, patient survival, and graft survival. LAR was defined as acute cellular rejection later than six months after liver transplant. Adult patients who had a minimum of 24 months of graft survival were included in this study. A total of 1604 case records of consecutive adult patients (over age 18 yr) who underwent liver transplant between 1985 and 2003 were reviewed. Of the 1604 patients, 305 (19.0%) developed LAR. Patients with primary diagnoses of autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis had higher incidences of LAR, while patients with metabolic disease and retransplant had lower incidence of LAR (p = 0.0024). The LAR group had more female and younger recipients than the no LAR group (p = 0.0026, p = 0.0131, respectively). Patient survival as well as graft survival were significantly lower in the LAR group (p = 0.0083, p = 0.0075, respectively). PTLD was the only significant independent predictor of late rejection. The careful management and treatment of PTLD, especially immunosuppressive management, is important to prevent LAR, which is related to poorer patient survival.

journal_name

Clin Transplant

journal_title

Clinical transplantation

authors

Uemura T,Ikegami T,Sanchez EQ,Jennings LW,Narasimhan G,McKenna GJ,Randall HB,Chinnakotla S,Levy MF,Goldstein RM,Klintmalm GB

doi

10.1111/j.1399-0012.2007.00788.x

subject

Has Abstract

pub_date

2008-05-01 00:00:00

pages

316-23

issue

3

eissn

0902-0063

issn

1399-0012

pii

CTR788

journal_volume

22

pub_type

杂志文章

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