In:
Clinical Transplantation, Wiley, Vol. 32, No. 2 ( 2018-02)
Abstract:
Chronic rejection ( CR ) is an uncommon but important cause of graft dysfunction, leading to graft loss and often requires retransplantation. This study evaluates the incidence and outcome of the patients with CR at a large living donor liver transplant ( LDLT ) center. Methods Data of patients with CR were retrospectively analyzed in 1232 adult (age 〉 18 years) LDLT on tacrolimus (mainly)‐based immunosuppression. Sirolimus/everolimus (mammalian target of rapamycin [ mTOR ] inhibitors) was added to baseline immunosuppression as rescue therapy in patients with CR . Data are shown as median ( interquartile range [IQR] ). Results Twenty‐three patients (22 males), aged 42 ( IQR 45‐56) years, had biopsy‐proven chronic rejection at 21 (8‐44) months after liver transplantation. The incidence of chronic rejection was 1.9% in this cohort. The patients with CR (n = 23) had a significantly higher incidence of cytomegalovirus ( CMV ) viremia, acute cellular rejection, and history of anastomotic biliary strictures as compared to patients without CR . Five patients were noncompliant with immunosuppression before the diagnosis of CR . Twelve patients (52%) responded to addition of mTOR inhibitors, whereas 11 did not respond and had poor outcome. Conclusion The incidence of chronic rejection is low in LDLT . Treatment with mTOR inhibitors can reverse graft dysfunction in approximately half of the patients.
Type of Medium:
Online Resource
ISSN:
0902-0063
,
1399-0012
DOI:
10.1111/ctr.2018.32.issue-2
Language:
English
Publisher:
Wiley
Publication Date:
2018
detail.hit.zdb_id:
2739458-X
detail.hit.zdb_id:
2004801-4
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