title: Allograft rejection after liver transplantation for autoimmune liver diseases.
abstract: Autoimmune liver diseases (AILD) may progress to liver failure, requiring liver transplantation as definitive therapy, and these immune-mediated disorders may predispose the patient to more frequent graft rejection. The objective of this study was to determine the effect of preexisting AILD on the incidence of allograft rejection after liver transplantation. Sixty-three patients who underwent liver transplantation between March 1988 and December 1994 for AILDs that included autoimmune hepatitis (AIH; n = 33) and primary biliary cirrhosis (PBC; n = 30) were retrospectively compared with 47 patients who underwent liver transplantation for alcoholic cirrhosis during the same time period. There was a lower incidence of acute allograft rejection in patients with AILD who received tacrolimus-based compared with cyclosporine-based immunosuppression (50% v 85.5%; P = .02). However, patients with AILDs overall had a higher incidence of acute rejection than patients with alcoholic cirrhosis (81% v 46.8%; P < .001), regardless of the type of immunosuppression. In addition, steroid-resistant rejection occurred more frequently in patients with AILDs than in patients with alcoholic cirrhosis (38.1% v 12.8%; P = .003). There was also a trend toward a higher incidence of chronic rejection in patients with AILDs compared with patients with alcoholic cirrhosis (11.1% v 2.1%), but this difference did not reach statistical significance. Patient and graft survivals at 1 and 3 years were similar between patients with AILDs and alcoholic liver disease. Compared with alcoholic cirrhosis, preexisting AILDs are associated with a higher incidence of acute allograft rejection and a trend toward more frequent chronic rejection.
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: M
authors.initials: M
authors.lastname: Hayashi
authors.forename: E B
authors.initials: EB
authors.lastname: Keeffe
authors.forename: S M
authors.initials: SM
authors.lastname: Krams
authors.forename: O M
authors.initials: OM
authors.lastname: Martinez
authors.forename: O N
authors.initials: ON
authors.lastname: Ojogho
authors.forename: S K
authors.initials: SK
authors.lastname: So
authors.forename: G
authors.initials: G
authors.lastname: Garcia
authors.forename: J C
authors.initials: JC
authors.lastname: Imperial
authors.forename: C O
authors.initials: CO
authors.lastname: Esquivel
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000401:mortality / Q000601:surgery*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D016572:Cyclosporine / Q000008:administration & dosage; D005260:Female; D006084:Graft Rejection; D019693:Hepatitis, Autoimmune / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016559:Tacrolimus / Q000008:administration & dosage; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011241:Prednisone; D016559:Tacrolimus