Chronic immune-mediated reaction syndrome as the cause of late graft mortality in living-donor liver transplantation for primary biliary cirrhosis

N. Harimoto, T. Ikegami, H. Nakagawara, Y. I. Yamashita, T. Yoshizumi, H. Uchiyama, Y. Soejima, T. Ikeda, K. Shirabe, S. Aishima, Y. Oda, Y. Maehara

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Abstract

Introduction Few studies to date have investigated the causes of late graft mortality after living-donor liver transplantation (LDLT) for primary biliary cirrhosis (PBC). Patients and Methods Fifty-five LDLTs for PBC were retrospectively reviewed. Factors prognostic of graft survival after LDLT were investigated, and histologic findings in patients with late graft loss were assessed. Results The 1-, 5-, and 10-year cumulative graft survival rates were 85.1%, 82.5%, and 66.9%, respectively. Multivariate Cox regression analysis found that male donor and ≥4 HLA mismatches were independently associated with poor graft survival. Among the 13 grafts lost, 5 were lost >1 year after LDLT, including 1 each due to chronic rejection, veno-occlusive disease, and obliterative portal venopathy, and 2 to other causes. Pathologic reviews of the serial biopsy specimens and explanted grafts from these 5 patients, with graft rejections from "chronic immune-mediated reaction syndrome," showed reciprocal changes over time. No patient died of recurrent PBC. Conclusions Male donor and ≥4 HLA mismatches were independent factors associated with poor graft survival. Late graft mortality after LDLT for PBC in some patients was due to chronic immune-mediated reaction syndrome, including chronic rejection, veno-occlusive disease, and obliterative portal venopathy, but not to recurrent PBC.

Original languageEnglish
Pages (from-to)1438-1443
Number of pages6
JournalTransplantation Proceedings
Volume46
Issue number5
DOIs
Publication statusPublished - Jun 2014

All Science Journal Classification (ASJC) codes

  • Surgery
  • Transplantation

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    Harimoto, N., Ikegami, T., Nakagawara, H., Yamashita, Y. I., Yoshizumi, T., Uchiyama, H., Soejima, Y., Ikeda, T., Shirabe, K., Aishima, S., Oda, Y., & Maehara, Y. (2014). Chronic immune-mediated reaction syndrome as the cause of late graft mortality in living-donor liver transplantation for primary biliary cirrhosis. Transplantation Proceedings, 46(5), 1438-1443. https://doi.org/10.1016/j.transproceed.2014.02.021