Risk factors for acute liver allograft rejection and their influences on treatment outcomes of rescue therapy in living donor liver transplantation.
Several clinical factors are reportedly correlated with acute cellular rejection (ACR) after liver transplantation. However, the factors that determine the response to rescue therapies remain unclear. A prospective database of 413 consecutive adult patients who underwent living donor liver transplantation (LDLT) was reviewed. Ninety-nine (24%) patients developed ACR after LDLT. A multivariate analysis revealed that a positive T-lymphocytotoxic test (odds ratio [OR], 3.85; P=.017), HLA-DR mismatch (OR, 2.99; P=.013), autoimmune disease (OR, 2.61; P=.001), and a younger recipient age (OR, 0.60 for +10 years; P<.001) were independent risk factors for ACR. Among these, autoimmune disease was significantly correlated with refractoriness to the standard rescue therapy (53% vs 30%, P=.02) and relapse of cellular rejection (34% vs 16%, P=.04). After rescue therapy, 98 of the 99 (99%) patients eventually recovered from ACR and graft loss was observed in only one patient. None of the risk factors for ACR impaired both graft survival and overall survival after LDLT. Autoimmune liver disease is associated with refractoriness to rescue therapy for ACR and the relapse of rejection. However, ACR does not affect the long-term outcomes of LDLT if it is well controlled.