title: The clinical significance of early histological rejection with or without biochemical abnormality in adult living donor liver transplantation for hepatitis B virus related end stage liver disease.
abstract: There is no agreement regarding the treatment of early allograft rejection (EAR) in adult living donor liver transplantation (LDLT). A protocol biopsy was performed in 62 adult LDLT recipients. Twenty-one patients (33.9%) had histological evidence of EAR. Of these, 14 patients had biochemical abnormalities and seven patients had no associated biochemical abnormalities. None of the seven patients with subclinical EAR (11.3% of the entire study population) were treated, and no subsequent rejection was observed. Gender mismatch (female-to-male) was the single independent risk factor for histological EAR [odds ratio (OR) = 13.458; 95% confidence interval (CI), 1.836-98.649] and the cumulative probability for a subsequent rejection was higher in patients with EAR (OR = 11.085; 95% CI, 1.221-100.654). However, the actuarial 1 year patient and graft survival rate in patients with EAR (81.0% and 85.5%) were similar to those without EAR (92.7% and 97.25%; P = 0.127 and 0.302, respectively). The presence of an initial biochemical abnormality was an independent risk factor for both a decreased patient survival (OR = 5.827; 95% CI, 1.095-31.017; P = 0.039) and graft loss (OR = 20.646; 95% CI, 2.044-208.524; P = 0.010). Subsequent rejection developed more frequently in patients with EAR. However, the survival is not determined by the presence of EAR but by the presence of a biochemical abnormality.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jai Young
authors.initials: JY
authors.lastname: Cho
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
authors.forename: Hae Won
authors.initials: HW
authors.lastname: Lee
authors.forename: Eung-Ho
authors.initials: EH
authors.lastname: Cho
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Yang
authors.forename: Yong Beom
authors.initials: YB
authors.lastname: Cho
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Min A
authors.initials: MA
authors.lastname: Kim
authors.forename: Ja-June
authors.initials: JJ
authors.lastname: Jang
authors.forename: Kuhn Uk
authors.initials: KU
authors.lastname: Lee
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology*; D006085:Graft Survival; D006509:Hepatitis B / Q000150:complications* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017114:Liver Failure, Acute / Q000276:immunology / Q000473:pathology / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000276:immunology / Q000401:mortality / Q000473:pathology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis
chemical_list: D007166:Immunosuppressive Agents