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. 2000 Jun 15;69(11):2330-6.
doi: 10.1097/00007890-200006150-00019.

Chronic liver allograft rejection in a population treated primarily with tacrolimus as baseline immunosuppression: long-term follow-up and evaluation of features for histopathological staging

K Blakolmer  1 , A Jain, K Ruppert, E Gray, R Duquesnoy, N Murase, T E Starzl, J J Fung, A J Demetris
Affiliations

Chronic liver allograft rejection in a population treated primarily with tacrolimus as baseline immunosuppression: long-term follow-up and evaluation of features for histopathological staging

K Blakolmer et al. Transplantation. .

Abstract

Background: Predisposing factors, long-term occurrence, and histopathological changes associated with recovery or progression to allograft failure from chronic rejection (CR) were studied in adult patients treated primarily with tacrolimus.

Methods: CR cases were identified using stringent criteria applied to a retrospective review of computerized clinicopathological data and slides.

Results: After 1973 days median follow-up, 35 (3.3%) of 1049 primary liver allograft recipients first developed CR between 16 and 2532 (median 242) days. The most significant risk factors for CR were the number (P<0.001) and histological severity (P<0.005) of acute rejection episodes and donor age >40 years (P<0.03). Other demographic and matching parameters were not associated with CR in this cohort. Ten patients died with, but not of, CR. Eight required retransplantation because of CR at a median of 268 days. Ten resolved either histologically or by normalization of liver injury tests over a median of 548 days. CR persisted for 340 to 2116 days in the remaining seven patients. More extensive bile duct loss (P<0.01), smallarterial loss (P<0.03), foam cell clusters (P<0.01) and higher total bilirubin (P<0.02) and aspartate aminotransferase (P<0.03) were associated with allograft failure from CR.

Conclusions: Early chronic liver allograft rejection is potentially reversible and a combination of histological, clinical, and laboratory data can be used to stage CR. Unique immunological and regenerative properties of liver allografts, which lead to a low incidence and reversibility of early CR, can provide insights into transplantation biology.

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Figures

FIGURE 1
FIGURE 1
Time to the first histopathological diagnosis of CR.
FIGURE 2
FIGURE 2
Time to onset of CR by donor age. All of the symbols represent cases of CR, and the outcome of the various cases are represented by the different symbols. (♦, graft failed or patient died, but not primarily because of CR; ▲, allograft failed because of CR; *, CR resolved as determined by liver injury tests and/or liver biopsy; +, patients with CR that neither resolved nor required retransplantation over the period of study) (see text).
See this image and copyright information in PMC

References

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