Incidence and severity of acute cellular rejection in recipients undergoing adult living donor or deceased donor liver transplantation

Abstract

Living donor liver transplantation (LDLT) may have better immunological outcomes compared to deceased donor liver transplantation (DDLT). The aim of this study was to analyze the incidence of acute cellular rejection (ACR) after LDLT and DDLT. Data from the adult-to-adult living donor liver transplantation (A2ALL) retrospective cohort study on 593 liver transplants done between May 1998 and March 2004 were studied (380 LDLT; 213 DDLT). Median LDLT and DDLT follow-up was 778 and 713 days, respectively. Rates of clinically treated and biopsy-proven ACR were compared. There were 174 (46%) LDLT and 80 (38%) DDLT recipients with >/=1 clinically treated episodes of ACR, whereas 103 (27%) LDLT and 58 (27%) DDLT recipients had >/=1 biopsy-proven ACR episode. A higher proportion of LDLT recipients had clinically treated ACR (p = 0.052), but this difference was largely attributable to one center. There were similar proportions of biopsy-proven rejection (p = 0.97) and graft loss due to rejection (p = 0.16). Longer cold ischemia time was associated with a higher rate of ACR in both groups despite much shorter median cold ischemia time in LDLT. These data do not show an immunological advantage for LDLT, and therefore do not support the application of unique posttransplant immunosuppression protocols for LDLT recipients.

Figures

Figure 1

Time interval from transplant to first clinically treated rejection for LDLT (with and without Center A) and DDLT recipients.

Figure 2

Time interval from transplant to first biopsy-proven rejection for LDLT and DDLT recipients.

Figure 3

Relative risk of biopsy-proven rejection for LDLT and DDLT transplants by cold ischemia time. The reference (hazard ratio = 1.0) is LDLT with 50 minutes of cold ischemia time. The hazard ratios are shown for the 5th to 95th percentiles of cold ischemia time within LDLT and DDLT. In addition, the lines are thicker in the regions of the 25th to 75th percentiles of cold ischemia time.