Incidence of rejection and infection after liver transplantation as a function of the primary disease: Possible influence of alcohol and polyclonal immunoglobulins

✍ Scribed by O Farges; F Saliba; H Farhamant; D Samuel; A Bismuth; M Reynes; H Bismuth

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 269 KB
• Volume: 23
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510230207

✦ Synopsis

lower, whereas the incidence of septic complications A retrospective analysis was undertaken to determine was comparable with that in the other groups. The inciif the incidence, timing, and severity of acute and dence of acute rejection in patients who have undergone chronic rejection were influenced by the primary distransplantation for nonviral disease receiving polyease necessitating transplantation. Of the 875 liver clonal human anti-cytomegalovirus (CMV) immunoglobtransplantations performed between 1984 and 1992, 768 ulins was also significantly lower than that of patients were primary transplantations and 107 were retranswho did not receive the immunoglobulins (19% vs. 48% plantations. Among the former, 330 patients that were at 3 months; P Å .01), and this was identical to that of liver transplant recipients for a chronic liver disease patients who have undergone transplantation for viral without cancer in the native liver received an ABO-comdisease receiving polyclonal human anti-HBs immunopatible and cross-match-negative graft and were given a cyclosporine-or tacrolimus-based immunosuppres-globulins (19% at 3 months). These results show that the sion. These included primary biliary cirrhosis (PBC, 66 risk of rejection is unequal among patients, being lower patients), primary sclerosing cholangitis (PSC, 23 pain patients who have undergone transplantation for tients), alcoholic cirrhosis (ALC, 21 patients), autoim-ALC (probably as a result of a state of nonspecific hypomune cirrhosis (AIC, 17 patients), hepatitis B virus-inresponsiveness) and in patients who have undergone duced cirrhosis (HBV-C, 116 patients) and hepatitis C transplantation for HBV-C (possibly as a result of longvirus-induced cirrhosis (HCV-C, 87 patients). The inciterm administration of polyclonal human immunoglobudence of acute (48% { 3% [SE] at 1 year) and chronic lins). (HEPATOLOGY 1996;23:240-248.) rejection (10% { 2% at 3 years) was comparable in patients who have undergone transplantation for PBC, PSC, AIC, and HCV-C. However, the incidence of acute The results of liver transplantation have regularly (but not chronic) rejection was significantly lower in improved over the past decade and data available from patients who have undergone transplantation for ALC both the Pitt-UNOS and the European Liver Trans-(29% at 1 year). This reduced incidence of acute rejection plant Registry registries indicate that the current 1was associated with an increased incidence of bacterial year graft survival rate exceeds 70%. 1,2 Analysis of the infections. In patients who have undergone transplantation for HBV-C (the majority of whom had received long-most recent figures however indicate that the rate of term anti-hepatitis B surface antigen [HBs] immunoimprovement in the survival curves has slowed down globulins), the incidence of both acute (21% at 1 year) during the past 2 years. 2 Failure to prevent rejection and chronic rejection (0% at 3 years) was significantly and complications from ''overimmunosuppression'' are still the predominant causes of failure and introduction of new immunosuppressive agents has not been associ-Abbreviations: CMV, cytomegalovirus; PBC, primary biliary cirrhosis; PSC, ated with an improved patient or graft survival. 3-5 primary sclerosing cholangitis; ALC, alcoholic cirrhosis; HBV, hepatitis B vi-These observations underline the limits of the current rus; HCV, hepatitis C virus; AIC, autoimmune cirrhosis; HBV-C, hepatitis B approach to immunosuppression. virus-induced cirrhosis; HCV-C, hepatitis C virus-induced cirrhosis; HBs,

This approach predominantly relies on the adminishepatitis B surface (antigen).