Clinical factors affecting rejection rates in liver transplantation

• Published in: Hepatobiliary & pancreatic diseases international Vol. 14; no. 4; pp. 367 - 373
• Main Authors: Au, Kin Pan, Chan, See-Ching, Chok, Kenneth Siu-Ho, Sharr, William Wei, Dai, Wing-Chiu, Sin, Sui-Ling, Wong, Tiffany Cho-Lam, Lo, Chung-Mau
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.08.2015
• Subjects: Acute Disease; acute rejection; Adult; Endocrinology & Metabolism; Female; Gastroenterology and Hepatology; Graft Rejection - diagnosis; Graft Rejection - immunology; Graft Rejection - mortality; Graft Rejection - prevention & control; Graft Survival - drug effects; Humans; immunosuppression; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Kaplan-Meier Estimate; liver transplantation; Liver Transplantation - adverse effects; Liver Transplantation - mortality; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome; 临床; 发生率; 受体拮抗剂; 慢性乙型肝炎; 排斥反应; 白细胞介素-2; 肝功能衰竭; 肝移植; acute rejection; immunosuppression; liver transplantation
• ISSN: 1499-3872
• DOI: 10.1016/S1499-3872(15)60391-5

With improvements in survival, liver transplant recipients now suffer more morbidity from long-term immunosuppression. Considerations were given to develop individualized immunosuppression based on their risk of rejection. We retrospectively analyzed the data of 788 liver transplants performed during the period from October 1991 to December 2011 to study the relationship between acute cellular rejection (ACR) and various clinical factors. Multivariate analysis showed that older age (P=0.04, OR=0.982), chronic hepatitis B virus infection (P=0.005, OR= 0.574), living donor liver transplantation (P=0.02, OR=0.648) and use of interleukin-2 receptor antagonist on induction (P<0.001, OR=0.401) were associated with fewer ACRs. Patients with fulminant liver failure (P=0.004, OR=4.05) were more likely to develop moderate to severe grade ACR. Liver transplant recipients with older age, chronic hepatitis B virus infection, living donor liver transplantation and use of interleukin-2 receptor antagonist on induction have fewer ACR. Patients transplanted for fulminant liver failure are at higher risk of moderate to severe grade ACR. These results provide theoretical framework for developing individualized immunosuppression.