Acute allograft rejection in liver transplant recipients: Incidence, risk factors, treatment success, and impact on graft failure

Abstract

ObjectiveThis study was performed to identify risk factors for acute cellular rejection after liver transplantation (LT).MethodsConsecutive LT recipients who underwent surgery in our institution from 2002 to 2015 were retrospectively evaluated.ResultsIn total, 176 patients were eligible for statistical analysis. During a mean observation period of 61.1 ± 36.3 months, 43 episodes of acute rejection were evident. Of these, 34 (79.0%) were responsive to methylprednisolone, 3 (7.0%) were treated by adjusting the dosage of immunosuppressive agents, and 6 (14.0%) were methylprednisolone-resistant and treated using anti-thymocyte globulin. Biliary complications (odds ratio [OR] = 4.89, 95% confidence interval [CI] = 2.00–11.98); donor-negative, recipient-positive CMV mismatch (OR = 9.88, 95% CI = 1.18–82.36); sex mismatch (OR = 3.16, 95% CI = 1.31–8.10); and sex mismatch with a female donor (OR = 3.00, 95% CI = 1.10–7.58) were identified as significant risk factors for acute graft rejection after LT.ConclusionIn patients who develop acute cellular rejection after LT, biliary complications should be evaluated as a potential cause. Most acute rejections after LT respond to bolus corticosteroid therapy.

Torque Teno Virus Is Associated With the State of Immune Suppression Early After Liver Transplantation

“…Despite the great advances made in immunosuppression (IS) in the past decades, the incidence of acute cellular rejection (ACR) after liver transplantation (LT) is still approximately 21%‐27% . In addition, IS therapy has significant adverse effects, including an increased risk of opportunistic infections, particularly during the first months following transplantation.…”

“…approximately 21%-27%. (1,2) In addition, IS therapy has significant adverse effects, including an increased risk of opportunistic infections, particularly during the first months following transplantation. Currently, the state of IS is evaluated using immunosuppressant levels as a surrogate marker.…”

Acute Cellular Rejection in Paediatric Liver Transplants: Does a Living Donor Ameliorate the Risk of Rejection in Our Patients? A Retrospective Review at Wits Donald Gordon Medical Centre, South Africa

“…It is further thought that T-memory cells that are generated in an inflammatory environment act as a barrier to tolerance induction. (10) This explanation gives credence to the observation of increasing ACR related to longer CITs (8,(15)(16)(17)(18) and biliary complications,(9) which are known to cause inflammation. Our data illustrates the increased risk of ACR with longer CIT; however, the expected increased risk of ACR was not shown in those patients with biliary complications.…”

“…The risk of ACR is thought to be highest in the early post-transplant period, and this risk declines over time with development of tolerance for the liver allograft. (10) In published studies, the incidence of ACR is reported between 7% (11) and 20%, (8,12) and even up to half of all recipients (3,4,13) although the time period over which 'acute rejection' can be diagnosed varies between studies, ranging between 3 (3,12,14) and 12 months. (11) The incidence of ACR of 22% in our cohort at 3 months is in keeping with extant literature, and on par with international standards.…”

Protein tyrosine phosphatase non‐receptor type 22 (PTPN22) gene polymorphisms in liver transplant donors and impact on acute cellular liver transplant rejection

“…Acute cellular rejection is a common complication after liver transplantation that occurs in about 20% to 40% liver transplant recipients. 1,2 It has been described that donor dendritic cells (DCs) as antigen-presenting cells are the main instigators of acute cellular liver transplant rejection due to their potent capacity to stimulate recipient T-cell responses against the graft. 3 DCs express the lymphoid-specific protein tyrosine phosphatase (Lyp) encoded by PTPN22 gene located on chromosome 1p13.3-13.1.…”