The clinical significance of early histological rejection with or without biochemical abnormality in adult living donor liver transplantation for hepatitis B virus related end stage liver disease

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Cho, Jai Young; Suh, Kyung-Suk; Lee, Hae Won; Cho, Eung-Ho; Yang, Sung Hoon; Cho, Yong Beom; Yi, Nam-Joon; Kim, Min A; Jang, Ja-June; Lee, Kuhn Uk
Issue Date
Blackwell Publishing
Transpl Int. 2007 Jan;20(1):37-44.
AdultBiopsyFemaleGraft Rejection/immunology/*pathologyGraft SurvivalHepatitis B/*complications/pathologyHumansImmunosuppressive Agents/therapeutic useLiver Failure, Acute/immunology/pathology/*surgery/virologyLiver Transplantation/immunology/mortality/*pathology*Living DonorsMaleMiddle AgedSurvival Analysis
There is no agreement regarding the treatment of early allograft rejection (EAR) in adult living donor liver transplantation (LDLT). A protocol biopsy was performed in 62 adult LDLT recipients. Twenty-one patients (33.9%) had histological evidence of EAR. Of these, 14 patients had biochemical abnormalities and seven patients had no associated biochemical abnormalities. None of the seven patients with subclinical EAR (11.3% of the entire study population) were treated, and no subsequent rejection was observed. Gender mismatch (female-to-male) was the single independent risk factor for histological EAR [odds ratio (OR) = 13.458; 95% confidence interval (CI), 1.836-98.649] and the cumulative probability for a subsequent rejection was higher in patients with EAR (OR = 11.085; 95% CI, 1.221-100.654). However, the actuarial 1 year patient and graft survival rate in patients with EAR (81.0% and 85.5%) were similar to those without EAR (92.7% and 97.25%; P = 0.127 and 0.302, respectively). The presence of an initial biochemical abnormality was an independent risk factor for both a decreased patient survival (OR = 5.827; 95% CI, 1.095-31.017; P = 0.039) and graft loss (OR = 20.646; 95% CI, 2.044-208.524; P = 0.010). Subsequent rejection developed more frequently in patients with EAR. However, the survival is not determined by the presence of EAR but by the presence of a biochemical abnormality.
0934-0874 (Print)
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College of Medicine/School of Medicine (의과대학/대학원)Surgery (외과학전공)Journal Papers (저널논문_외과학전공)
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