Effect of immunosuppressive regimen on acute rejection and liver graft function.
Despite the use of modern immunosuppressive drugs, acute liver rejection (AR) continues to affect up to 70% of transplant recipients. The aim of this retrospective study was to assess the incidence of acute rejection episodes in patients treated with different immunosuppressive protocols. In our series, 37.3% of patients developed a clinical episode of AR. Analysis of immunosuppression has shown that the most effective immunosuppressive protocols, with regard to prevention of AR, include: antibody anti-IL-2R (anti-IL-2R) + tacrolimus (Tac) + mycophenolate mofetil (MMF) + prednisolone (Pred); anti-IL-2R + tacrolimus (Tac) + Pred; or Tac + Pred (25% vs 28.6% vs 30.4%, respectively). The highest rate of AR (66.6%) was observed among patients with anti-IL-2R and Tac but no steroid treatment, mostly (77.7%) in the initial period after liver transplantation. There were no statistical differences in liver function tests between the group treated with a CsA-based versus a Tac-based therapy. Strong immunosuppression contributed to a relatively low incidence of clinical AR in our series. The lowest rate of AR was observed among patients treated with anti-IL-2R antibody. Tac, and Pred. Deprivation of steroids in the early phase after liver transplantation substantially increased the risk of acute rejection episodes despite the use of anti-CD25. There were no statistically significant differences in liver function tests among those treated with Tac versus CsA in the short-term follow-up.
Ziolkowski
J
J
Department of Immunology, Transplant Medicine, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Paczek
L
L
Niewczas
M
M
Senatorski
G
G
Oldakowska-Jedynak
U
U
Wyzgal
J
J
Foroncewicz
B
B
Mucha
K
K
Zegarska
J
J
Nyckowski
P
P
Zieniewicz
K
K
Patkowski
W
W
Krawczyk
M
M
Ziarkiewicz-Wroblewska
B
B
Gornicka
B
B
D000208:Acute Disease; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000077552:Basiliximab; D016572:Cyclosporine / Q000627:therapeutic use; D000077561:Daclizumab; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000276:immunology* / Q000502:physiology; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D016572:Cyclosporine; D000077552:Basiliximab; D000077561:Daclizumab; D009173:Mycophenolic Acid; D016559:Tacrolimus