title: Clinical factors affecting rejection rates in liver transplantation.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, the University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong SAR, China. seechingchan@gmail.com.
authors.forename: Kin Pan
authors.initials: KP
authors.lastname: Au
authors.forename: See-Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Kenneth Siu-Ho
authors.initials: KS
authors.lastname: Chok
authors.forename: William Wei
authors.initials: WW
authors.lastname: Sharr
authors.forename: Wing-Chiu
authors.initials: WC
authors.lastname: Dai
authors.forename: Sui-Ling
authors.initials: SL
authors.lastname: Sin
authors.forename: Tiffany Cho-Lam
authors.initials: TC
authors.lastname: Wong
authors.forename: Chung-Mau
authors.initials: CM
authors.lastname: Lo
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents