title: Prognostic factors for the evolution and reversibility of chronic rejection in pediatric liver transplantation.
abstract: OBJECTIVE
  Chronic rejection remains a major cause of graft failure with indication for re-transplantation. The incidence of chronic rejection remains high in the pediatric population. Although several risk factors have been implicated in adults, the prognostic factors for the evolution and reversibility of chronic rejection in pediatric liver transplantation are not known. Hence, the current study aimed to determine the factors involved in the progression or reversibility of pediatric chronic rejection by evaluating a series of chronic rejection cases following liver transplantation.
  
  
  METHODS
  Chronic rejection cases were identified by performing liver biopsies on patients based on clinical suspicion. Treatment included maintaining high levels of tacrolimus and the introduction of mofetil mycophenolate. The children were divided into 2 groups: those with favorable outcomes and those with adverse outcomes. Multivariate analysis was performed to identify potential risk factors in these groups.
  
  
  RESULTS
  Among 537 children subjected to liver transplantation, chronic rejection occurred in 29 patients (5.4%). In 10 patients (10/29, 34.5%), remission of chronic rejection was achieved with immunosuppression (favorable outcomes group). In the remaining 19 patients (19/29, 65.5%), rejection could not be controlled (adverse outcomes group) and resulted in re-transplantation (7 patients, 24.1%) or death (12 patients, 41.4%). Statistical analysis showed that the presence of ductopenia was associated with worse outcomes (risk ratio=2.08, p=0.01).
  
  
  CONCLUSIONS
  The presence of ductopenia is associated with poor prognosis in pediatric patients with chronic graft rejection.
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Ana Cristina Aoun
authors.initials: AC
authors.lastname: Tannuri
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Lima
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Evandro Sobroza de
authors.initials: ES
authors.lastname: Mello
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Ryan Yukimatsu
authors.initials: RY
authors.lastname: Tanigawa
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Uenis
authors.initials: U
authors.lastname: Tannuri
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology / Q000473:pathology; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D007674:Kidney Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D015999:Multivariate Analysis; D009173:Mycophenolic Acid / Q000627:therapeutic use; D011379:Prognosis; D012074:Remission Induction; D015996:Survival Rate; D016559:Tacrolimus / Q000097:blood / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D016559:Tacrolimus