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. 2006 Nov 7;12(41):6674-7.
doi: 10.3748/wjg.v12.i41.6674.

Late-onset acute rejection after living donor liver transplantation

Nobuhisa Akamatsu  1 , Yasuhiko Sugawara, Sumihito Tamura, Junichi Keneko, Yuichi Matsui, Kiyoshi Hasegawa, Masatoshi Makuuchi
Affiliations

Late-onset acute rejection after living donor liver transplantation

Nobuhisa Akamatsu et al. World J Gastroenterol. .

Abstract

Aim: To investigate the incidence and risk factors of late-onset acute rejection (LAR) and to clarify the effectiveness of our immunosuppressive regime consisting of life-long administration of tacrolimus and steroids.

Methods: Adult living donor liver transplantation recipients (n=204) who survived more than 6 mo after living donor liver transplantation were enrolled. Immunosuppression was achieved using tacrolimus and methylprednisolone. When adverse effects of tacrolimus were detected, the patient was switched to cyclosporine. Six months after transplantation, tacrolimus or cyclosporine was carefully maintained at a therapeutic level. The methylprednisolone dosage was maintained at 0.05 mg/kg per day by oral administration. Acute rejections that occurred more than 6 mo after the operation were defined as late-onset. The median follow-up period was 34 mo.

Results: LAR was observed in 15 cases (7%) and no chronic rejection was observed. The incidence of hyperlipidemia, chronic renal failure, new-onset post-transplantation diabetes, and deep fungal infection were 13%, 2%, 24%, and 17%, respectively. Conversion from tacrolimus to cyclosporine was required in 38 patients (19%). Multivariate analysis revealed that a cyclosporine-based regimen was significantly associated with LAR.

Conclusion: Both LAR and drug-induced adverse events happen at a low incidence, supporting the safety and efficacy of the present immunosuppression regimen for living donor liver transplantation.

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Figures

Figure 1
Figure 1
Kaplan-Meier plot of LAR-free survival based on immunosuppression. Thick line: patients with tacrolimus (n = 166); thin line: those with cyclosporine (n = 38). P < 0.0001 comparison between patients with tacrolimus and cyclosporine.
See this image and copyright information in PMC

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