Chronic Allograft Rejection

Häyry, P; Isoniemi, Helena; Yılmaz, Serdar; Mennander, Ari; Lemström, Karl; Räisänen‐Sokolowski, Anne; Koskinen, Petri; Ustinov, Jarkko; Lautenschlager, I; Taskinen, Eero; Krogerus, Leena; Aho, Päivi; Paavonen, Timo

doi:10.1111/j.1600-065x.1993.tb00639.x

Cited by 230 publications

(93 citation statements)

References 78 publications

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“…[3][4][5]26,27 The use of azathioprine is associated with a significantly lower incidence of CR. 7 The results from our center and multicenter trials have suggested that CR can be successfully treated by conversion to tacrolimus-based immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

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Does tacrolimus offer virtual freedom from chronic rejection after primary liver transplantation? Risk and prognostic factors in 1,048 liver transplantations with a mean follow-up of 6 years

Jain

Demetris

Kashyap

et al. 2001

Liver Transplantation

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Tacrolimus has proven to be a potent immunosuppressive agent in liver transplantation (LT). Its introduction has led to significantly less frequent and severe acute rejection. Little is known about the rate of chronic rejection (CR) in primary LT using tacrolimus therapy. The aim of the present study is to examine the long-term incidence of CR, risk factors, prognostic factors, and outcome after CR. The present study evaluated the development of CR in 1,048 consecutive adult primary liver allograft recipients initiated and mostly maintained on tacrolimus-based immunosuppressive therapy. They were evaluated with a mean follow-up of 77.3 ؎ 14.7 months (range, 50.7 to 100.1 months). To assess the impact of primary diagnosis on the rate and outcome of CR, the population was divided into 3 groups. Group I included patients with hepatitis C virus (HCV)-or hepatitis B virus (HBV)-induced cirrhosis (n ‫؍‬ 312); group II included patients diagnosed with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), or autoimmune hepatitis (AIH; n ‫؍‬ 217); and group III included patients with all other diagnoses (n ‫؍‬ 519). Overall, 32 of 1,048 patients (3.1%) developed CR. This represented 13 (4.1%), 12 (5.5%), and 7 patients (1.3%) in groups I, II, and III, respectively. The relative risk for developing CR was 3.2 times greater for group I and 4.3 times greater for group II compared with group III. This difference was statistically significant (P ‫؍‬ .004). The incidence of acute rejection and total number of acute rejection episodes were significantly greater in patients who developed CR compared with those who did not (P < .0001). Similarly, the mean donor age for CR was significantly older than for patients without CR (43.0 v 36.2 years; P ‫؍‬ .02). Thirteen of the 32 patients (40.6%) who developed CR retained their original grafts for a mean period of 54 ؎ 25 months after diagnosis. Seven patients (21.9%) underwent re-LT, and 12 patients (38.3%) died. Serum bilirubin levels and the presence of arteriopathy, arterial loss, and duct loss on liver biopsy at the time of diagnosis of CR were significantly greater among the 3 groups of patients. In addition, patient and graft survival for group I were significantly worse compared with groups II and III. We conclude that CR occurred rarely among patients maintained long term on tacrolimus-based immunosuppressive therapy. When steroid use is controlled, the incidence of acute rejection, mean donor age, HBV-and/or HCV-induced cirrhosis, or a diagnosis of PBC, PSC, or AIH were found to be predictors of CR. Greater values for serum bilirubin level, duct loss, arteriopathy, arteriolar loss, and presence of HCV or HBV were found to be poor prognostic factors for the 3 groups; greater total serum bilirubin value (P ‫؍‬ .05) was the only factor found to be significant between patients who had graft loss versus those who recovered. (Liver Transpl 2001;7:623-630.)

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Section: Discussionmentioning

confidence: 99%

“…1,2 However, chronic rejection (CR) occurs in 2% to 20% of successful liver transplant recipients treated with CsA, and re-LT may be necessary. [1][2][3][4][5][6] Even after re-LT, the recurrence rate of CR is as high as 90%. 7 The introduction of tacrolimus into primary LT has resulted in a significant reduction in the rate of acute rejection.…”

mentioning

confidence: 99%

Does tacrolimus offer virtual freedom from chronic rejection after primary liver transplantation? Risk and prognostic factors in 1,048 liver transplantations with a mean follow-up of 6 years

Jain

Demetris

Kashyap

et al. 2001

Liver Transplantation

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“…As a consequence cellular events will occur, which include smooth muscle cell migration into the intima and proliferation, fibroblast proliferation and an increased formation and deposition of extracellular matrix proteins. 7 These events will eventually lead to long-term deterioration of graft function, designated CVR.…”

Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

“…This is also called chronic rejection (CVR) or chronic transplant dysfunction, which is considered to be one of the leading causes of long-term failure of transplanted hearts and kidneys. [5][6][7][8] It has been estimated from various investigations that there is a 3-4% annual loss of transplanted kidneys due to chronic rejection Ͼ1 year post-transplantation. In …”

Section: Introductionmentioning

confidence: 99%

Accelerated atherosclerosis in the transplant recipient: role of hypertension

et al. 1998

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An accelerated atherosclerosis may occur in the native arteries of a transplant recipient as well as in arteries of transplanted kidneys or hearts. The dominating cause of patient mortality are cardiovascular diseases, where ischaemic heart disease is predominant. The accelerated form of arteriosclerosis which takes place in transplanted kidneys and hearts, has a complex pathogenesis, which includes both immunological and non-

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“…and destruction and atrophy of parenchymal elements and organ-associated lymphoid tissue [89. 120,125]. The term chronic implies a temporally prolonged course and.…”

Section: Chronic Rejectionmentioning

confidence: 99%

Dendritic cells in rejection and acceptance of solid organ allografts

Murase

et al. 2001

Dendritic Cells

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Chronic Allograft Rejection

Cited by 230 publications

References 78 publications

Does tacrolimus offer virtual freedom from chronic rejection after primary liver transplantation? Risk and prognostic factors in 1,048 liver transplantations with a mean follow-up of 6 years

Does tacrolimus offer virtual freedom from chronic rejection after primary liver transplantation? Risk and prognostic factors in 1,048 liver transplantations with a mean follow-up of 6 years

Accelerated atherosclerosis in the transplant recipient: role of hypertension

Dendritic cells in rejection and acceptance of solid organ allografts

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