The purpose of this study was to compare the inci-dence and severity of rejection episodes in a group of dence and severity of rejection episodes in a group of children receiving living related orthotopic liver transchildren receiving living related orthotopic liver transplants (LRLT) versus patients receiving cadaveric liver plants (LRLT) versus children receiving cadaveric liver transplants (CLT).
transplants (CLT). Thirty-eight patients received pri-PATIENTS AND METHODS mary LRLT and 54 patients received CLT during a 3-year period ending June 1993. Baseline immunosuppression
The study population included all pediatric patients underconsisted of cyclosporin, azathioprine, and corticostegoing primary orthotopic liver transplantation at the Univerroids. Rejection episodes were confirmed by liver histolsity of Chicago during a 3-year period beginning June 1990. ogy and were treated initially with pulse intravenous Patients were divided into two groups: those receiving their methylprednisolone, 10 mg/kg/d for 3 days. Steroid-resisfirst liver transplant from a cadaveric donor (CLT), and those tant rejection was treated with OKT3 or FK506. The mereceiving their first graft from a living related donor (LRLT). dian patient ages were 1.3 years for the CLT and .8 years Patients who died or required a second transplantation durfor the LRLT recipients. Acute cellular rejection develing the first 7 postoperative days were excluded from the oped in 78% of the CLT grafts and 74% of the LRLT grafts study groups. Patients were also excluded if they were partic-(P Γ
ns). However, steroid-resistant rejection was signifiipating in an experimental protocol studying primary immucantly less frequent in the LRLT recipients, 13% versus nosuppression with FK506, although evaluation of data with 43% in the CLT recipients (P Γ΅ .01). Ductopenic rejection the inclusion of this cohort of patients yielded similar results. was diagnosed in 20% of CLT and 8% of LRLT grafts (P All patients had regular evaluation from the time of transΓ΅ .10), and graft loss caused by rejection was 9% in the plantation, which resulted in a follow-up period of 12 to 48 CLT and 3% in the LRLT group (P Γ
ns). In conclusion, months. Evaluation for clinical or biochemical evidence of the overall incidence of rejection is the same in LRLT rejection was performed at least monthly for the first 6 and CLT recipients, but LRLT recipients are less likely months after transplantation and then at least every 3 than CLT recipients to develop steroid-resistant rejecmonths for 1 year. Patients who were 18 months posttranstion or ductopenic rejection. (HEPATOLOGY 1996;23:40plantation were evaluated at 6-month intervals if there had 43.) been no rejection in the preceding observation period. Data were collected by retrospective chart review and included episodes of rejection, immunosuppressive therapy, to .3 mg/kg/d by the twenty-eighth postoperative day; and transplants; MHC, major histocompatibility complex. azathioprine 1 mg/kg/d. 9,10 Six months posttransplantation, From the Departments of