title: Low incidence of acute rejection after living-donor liver transplantation: immunologic analyses by mixed lymphocyte reaction using a carboxyfluorescein diacetate succinimidyl ester labeling technique.
abstract: BACKGROUND
  To monitor antidonor alloreactivity for accurate diagnosis of acute rejection after living-donor liver transplantation (LDLT), we used a mixed lymphocyte reaction (MLR) assay using an intracellular fluorescent dye carboxyfluorescein diacetate succimidyl ester (CFSE)-labeling technique (CFSE-MLR) in 29 consecutive patients who underwent adult-to-adult LDLT.
  
  
  METHODS
  For patients who developed moderate or severe disorders in liver function, CFSE-MLR was performed together with needle biopsy of the liver allografts immediately after liver dysfunction had occurred. CFSE-labeled peripheral blood mononuclear cells (PBMC) from recipients and irradiated autologous, donor, or third-party PBMC were cultured, and then proliferation and CD25 expression in each of the CD4+ and CD8+ T cell subsets were analyzed by flow cytometry.
  
  
  RESULTS
  Twelve (41.4%) of the 29 patients developed moderate or severe disorders in liver function within 6 months after LDLT. Eight of the 12 patients (overall incidence of 27.6%) suffering from liver function disorder were diagnosed on the basis of liver biopsy results as having mild or moderate acute rejection. However, only 4 of the 12 patients (overall incidence of 13.8%) showed remarkable proliferation of CD8+ T cells in association with CD25 expression on antidonor CFSE-MLR. The other eight patients were eventually diagnosed as having recurrence of original hepatitis, drug-induced hepatotoxicity, or congestion of the anterior segment of the liver allograft by further extensive examinations or in retrospect.
  
  
  CONCLUSIONS
  The results of CFSE-MLR assays, which could be used for rigorously monitoring rejection, provided evidence of low incidence of acute rejection after LDLT.
authors.affiliation: Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima University, Minami-ku, Hiroshima, Japan. hohdan@hiroshima-u.ac.jp
authors.forename: Yuka
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
authors.forename: Takashi
authors.initials: T
authors.lastname: Onoe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mitsuta
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Tashiro
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Itamoto
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Asahara
mesh_terms: D000328:Adult; D001706:Biopsy; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D005260:Female; D005434:Flow Cytometry; D005452:Fluoresceins; D006084:Graft Rejection / Q000453:epidemiology* / Q000276:immunology / Q000473:pathology; D006801:Humans; D015994:Incidence; D007564:Japan; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology* / Q000473:pathology; D019520:Living Donors; D007959:Lymphocyte Culture Test, Mixed; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D005452:Fluoresceins; C027780:carboxyfluoresceindiacetate