Allograft rejection in pediatric recipients of living related liver transplants

Abstract

The purpose of this study was to compare the inci-dence and severity of rejection episodes in a group of dence and severity of rejection episodes in a group of children receiving living related orthotopic liver transchildren receiving living related orthotopic liver trans-plants (LRLT) versus patients receiving cadaveric liver plants (LRLT) versus children receiving cadaveric liver transplants (CLT). transplants (CLT). Thirty-eight patients received pri-PATIENTS AND METHODS mary LRLT and 54 patients received CLT during a 3-year period ending June 1993. Baseline immunosuppressionThe study population included all pediatric patients underconsisted of cyclosporin, azathioprine, and corticoste-going primary orthotopic liver transplantation at the Univerroids. Rejection episodes were confirmed by liver histol-sity of Chicago during a 3-year period beginning June 1990. ogy and were treated initially with pulse intravenous Patients were divided into two groups: those receiving their methylprednisolone, 10 mg/kg/d for 3 days. Steroid-resis-first liver transplant from a cadaveric donor (CLT), and those tant rejection was treated with OKT3 or FK506. The me-receiving their first graft from a living related donor (LRLT). dian patient ages were 1.3 years for the CLT and .8 years Patients who died or required a second transplantation durfor the LRLT recipients. Acute cellular rejection devel-ing the first 7 postoperative days were excluded from the oped in 78% of the CLT grafts and 74% of the LRLT grafts study groups. Patients were also excluded if they were partic-(P Å ns). However, steroid-resistant rejection was signifi-ipating in an experimental protocol studying primary immucantly less frequent in the LRLT recipients, 13% versus nosuppression with FK506, although evaluation of data with 43% in the CLT recipients (P õ .01). Ductopenic rejection the inclusion of this cohort of patients yielded similar results. was diagnosed in 20% of CLT and 8% of LRLT grafts (P All patients had regular evaluation from the time of trans-õ .10), and graft loss caused by rejection was 9% in the plantation, which resulted in a follow-up period of 12 to 48 CLT and 3% in the LRLT group (P Å ns). In conclusion, months. Evaluation for clinical or biochemical evidence of the overall incidence of rejection is the same in LRLT rejection was performed at least monthly for the first 6 and CLT recipients, but LRLT recipients are less likely months after transplantation and then at least every 3 than CLT recipients to develop steroid-resistant rejec-months for 1 year. Patients who were 18 months posttranstion or ductopenic rejection. (HEPATOLOGY 1996;23:40-plantation were evaluated at 6-month intervals if there had 43.) been no rejection in the preceding observation period. Data were collected by retrospective chart review and included episodes of rejection, immunosuppressive therapy, Orthotopic liver transplantation using a segment of graft loss caused by rejection, and overall survival. Average liver from a living adult donor has become an accepted who...

Cadaveric full-size liver transplantation and the graft alternatives in adults: A comparative study from a single centre

“…Discordant results have been reported depending essentially on the population studied. In pediatric series, although the overall incidence of AR between LDLT and CAD patients is similar [2][3][4][5], a significant reduction of the incidence of AR after 1 year post-LT and steroid resistant AR is reported in LDLT patients [2,5]. In an adult series [8], the immunologic benefit of LDLT seems to be more significant.…”

“…The CR rate in our LDLT patients was 16% (6/38), using the Banff criteria including early and late stages. This rate was 5% (2/38 cases with late CR), if the rate of ductopenia O50% of portal tracts is retained as diagnostic of CR, as the authors did in their series [2,21]. This rate is comparable to the CR rates in the pediatric population.…”

“…This rate is comparable to the CR rates in the pediatric population. With regard to the outcome, none of our patients with CR evolved towards graft failure due to CR, while pediatric patients with CR did, with a rate of 2 and 3% of the LDLT population, in two studies [22,2], respectively. The second comparison concerns the development of arterial thrombosis and biliary complications.…”

“…Only two pediatric series compared the CR rates between LDLT and CAD patients: Gupta et al [21] reported significantly lower CR rates in the LDLT patients than in the CAD patients (4 versus 16%, respectively), independently from the type of primary immunosuppression. Alonso et al [2] obtained a trend towards lower rates in the LDLT patients than in the CAD patients under cyclosporine (8 versus 20%, respectively). This is in contrast with our study, where there was no difference in the incidence of CR between the groups at any time.…”

“…Most of the comparative studies are restricted to clinical data without histological follow-up, comparing the LDLT and CAD patients in the pediatric [2][3][4][5][6][7] and adult [8][9][10][11] population. In addition, in the pediatric population the CAD patients do not constitute a homogenous group, as they include also SLT patients [2,3,5].…”