Acute hepatic allograft rejection: Incidence, risk factors, and impact on outcome

Russell H. Wiesner, A. Jake Demetris, Steven H. Belle, Eric C. Seaberg, John R. Lake, Rowen K. Zetterman, James Everhart, Katherine M. Detre

Research output: Contribution to journalArticle

346 Citations (Scopus)

Abstract

Hepatic allograft rejection remains an important problem following liver transplantation, and, indeed, complications related to the administration of immunosuppressive therapy remain a predominant cause of posttransplantation morbidity and mortality. The Liver Transplantation Database (LTD) was used to study a cohort of 762 consecutive adult liver transplantation recipients and determined the incidence, timing, and risk factors for acute rejection. We also evaluated the impact of histological severity of rejection on the need for additional immunosuppressive therapy and on patient and graft survival. Four hundred ninety (64%) of the 762 adult liver transplantation recipients developed at least one episode of rejection during a median follow-up period of 1,042 days (range, 336-1,896 days), most of which occurred during the first 6 weeks after transplantation. Multivariate analysis revealed that recipient age, serum creatinine, aspartate transaminase (AST) level, presence of edema, donor/recipient HLA-DR mismatch, cold ischemic time, and donor age were independently associated with the time to acute rejection. An interesting observation was that the histological severity of rejection was an important prognosticator: the use of antilymphocyte preparations was higher, and the time to death or retransplantation was shorter, for patients with severe rejection. Findings from this study will assist in decision- making for the use of immunosuppressive regimens and call into question whether complete elimination of all rejection or alloreactivity is a desirable goal in liver transplantation.

Original languageEnglish (US)
Pages (from-to)638-645
Number of pages8
JournalHepatology
Volume28
Issue number3
StatePublished - 1998

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Allografts
Liver Transplantation
Liver
Incidence
Immunosuppressive Agents
Tissue Donors
Cold Ischemia
Rejection (Psychology)
HLA-DR Antigens
Graft Survival
Aspartate Aminotransferases
Edema
Creatinine
Decision Making
Cohort Studies
Multivariate Analysis
Transplantation
Observation
Databases
Morbidity

ASJC Scopus subject areas

  • Hepatology

Cite this

Wiesner, R. H., Demetris, A. J., Belle, S. H., Seaberg, E. C., Lake, J. R., Zetterman, R. K., ... Detre, K. M. (1998). Acute hepatic allograft rejection: Incidence, risk factors, and impact on outcome. Hepatology, 28(3), 638-645.

Acute hepatic allograft rejection : Incidence, risk factors, and impact on outcome. / Wiesner, Russell H.; Demetris, A. Jake; Belle, Steven H.; Seaberg, Eric C.; Lake, John R.; Zetterman, Rowen K.; Everhart, James; Detre, Katherine M.

In: Hepatology, Vol. 28, No. 3, 1998, p. 638-645.

Research output: Contribution to journalArticle

Wiesner, RH, Demetris, AJ, Belle, SH, Seaberg, EC, Lake, JR, Zetterman, RK, Everhart, J & Detre, KM 1998, 'Acute hepatic allograft rejection: Incidence, risk factors, and impact on outcome', Hepatology, vol. 28, no. 3, pp. 638-645.
Wiesner RH, Demetris AJ, Belle SH, Seaberg EC, Lake JR, Zetterman RK et al. Acute hepatic allograft rejection: Incidence, risk factors, and impact on outcome. Hepatology. 1998;28(3):638-645.
Wiesner, Russell H. ; Demetris, A. Jake ; Belle, Steven H. ; Seaberg, Eric C. ; Lake, John R. ; Zetterman, Rowen K. ; Everhart, James ; Detre, Katherine M. / Acute hepatic allograft rejection : Incidence, risk factors, and impact on outcome. In: Hepatology. 1998 ; Vol. 28, No. 3. pp. 638-645.
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