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

Abstract

Background: Despite the enlarging pool of paediatric liver transplants (LT), there is a paucity of data-detailing risk factors for acute cellular rejection (ACR). Objective: To identify risk factors associated with ACR. Method: We reviewed the data of 98 paediatric patients at Wits Donald Gordon Medical Centre who underwent LT between 2015 and 2018, and subsequent histologically determined ACR. Results: Of the 98 patients who received a LT, 52% of donors were deceased donors and 48% were living donors. Twentytwo per cent of the patients were diagnosed with ACR during the first 90 days post LT. Sixty-eight per cent of living donor liver transplants were in the shortest (less than 2.5 h) cold ischaemic time (CIT) tertile, while 0% of deceased donor organs were transplanted prior to 2.5 h. We identified decreased CIT and living donor status as factors, both closely related to each other and associated with a decreased risk of ACR. Conclusion: CIT is associated with a decreased risk of ACR. Living donor LT is associated with a decreased CIT and as a result a less inflammatory milieu in the early post LT period. Further research should be conducted, with particular reference to a decreased risk of ACR in living donor paediatric LT, in order to better inform immunosuppressive therapeutic regimens.