title: Re-Transplantation, Higher Creatinine Levels in Hepatitis C Virus Patients, and Donor Age Are Predictors of Mortality in Long-Term Analysis of Late Acute Rejection in Liver Transplantation.
abstract: BACKGROUND Late acute rejection (LAR) differs in its clinical and histological presentation and management from early acute rejection. This clinical entity is not completely understood; thus, we aimed to identify significant prognostic factors that can influence post-transplant survival in LAR patients. The purpose of this study was to evaluate the incidence and post-transplant survival of patients from a single center with a focus on late acute rejection. MATERIAL AND METHODS From January 2002 to June 2013, all liver biopsies from patients with rejection were scored using the Banff criteria. The groups were compared, and simple and multiple logistic regression and survival curves were created. RESULTS A total of 779 liver transplants were performed; 585 patients with no rejections and 194 patients with rejections were analyzed. The overall incidence of LAR was 6.7%, and there was a higher prevalence of early acute cellular rejection than LAR. The mean time to LAR was 564 days (median 214 days, range 91-2642). LAR had a more severe grade (35.3%) than early acute rejection (23.5%). The survival rates were similar between both modalities for the long-term period. Worse mortality rates were observed in liver re-transplantation (HR 4.77; p<0.0001); in hepatitis C virus patients with increased creatinine levels (HR 22.48; p=0.016); and in donors >41 years of age (OR 2.1; p=0.047) in a long-term analysis of LAR. CONCLUSIONS Liver re-transplantation, higher creatinine levels in hepatitis C virus patients, and donor age were predictors of mortality in this long-term analysis of late acute rejection in liver transplantation.
authors.affiliation: Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Lucas Souto
authors.initials: LS
authors.lastname: Nacif
authors.affiliation: Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Rafael Soares
authors.initials: RS
authors.lastname: Pinheiro
authors.affiliation: Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Rafael Antônio
authors.initials: RA
authors.lastname: de Arruda Pécora
authors.affiliation: Department of Pathology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Ryan Yukimatsu
authors.initials: RY
authors.lastname: Tanigawa
authors.affiliation: Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Vinicius
authors.initials: V
authors.lastname: Rocha-Santos
authors.affiliation: Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Wellington
authors.initials: W
authors.lastname: Andraus
authors.affiliation: Department of Pathology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Venancio Avancini Ferreira
authors.initials: VA
authors.lastname: Alves
authors.affiliation: Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Luiz Carneiro
authors.initials: LC
authors.lastname: D'Albuquerque
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood*; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000401:mortality*; D006526:Hepatitis C / Q000097:blood / Q000401:mortality / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012307:Risk Factors; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D003404:Creatinine