Incidence and severity of acute allograft rejection in liver transplant recipients treated with alfa interferon

A. Jain, A. J. Demetris, R. Manez, A. C. Tsamanadas, D. Van Thiel, Jorge Rakela, T. E. Starzl, J. J. Fung

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Interferon alfa-2b (IFN-α) therapy has been shown to be effective in the treatment of viral hepatitis B (HBV) or viral hepatitis C (HCV) in patients who did not undergo transplantation. However, in allograft recipients, treatment with IFN-α often leads to allograft rejection. The aim of the present study was to determine if IFN-α therapy increases the incidence or severity of acute rejection in human liver allograft recipients. One hundred five orthotopic liver transplant (OLT) recipients with HBV (n = 32), HCV (n = 58), or Non A Non B Non C (n = 15) viral infections were treated with a 6-month course of IFN-α, 5 million U subcutaneously three times a week, which began 2 to 97 months after transplantation. The mean hepatitis activity index (HAI) at the beginning of the therapy was 10.1 ± 3.0. The baseline immunosuppression was achieved by tacrolimus in 77 patients and by cyclosporine A (CyA) in 28 patients. Contemporaneous controls consisted of 132 OLT patients (100 who received tacrolimus and 32 who received CyA) who did not receive IFN-α. A retrospective analysis was performed on this group of patients. The incidence of rejection and the baseline immunosuppression were compared. All biopsies were reviewed without knowledge of clinical data and scored for HAI and for rejection activity index (RAI). The biochemical response to IFN-α was also examined. The mean baseline maintenance dose of prednisone was greater by 2 mg daily in patients who received IFN-α with tacrolimus compared with control patients who did not receive IFN-α with tacrolimus (IFN-α 5.3 ± 5.2 mg daily v controls 3.3 ± 4.9 mg daily; P ≤ .05). Similarly, the mean maintenance dose of prednisone was greater by 2.5 mg daily in patients who received IFN-α compared with controls who received CyA-based immunosuppression (IFN-α 9.8 ± 3.1 mg daily v controls 7.3 ± 3.3 mg daily; P = .01). Acute rejection episodes were detected in 10.5% (n = 11) of IFN-α-treated patients compared with 8.8% of controls for the similar time period from OLT and period of exposure to risk of rejection. Mean RAI was 2.0 ± 2.4 for the IFN-α- treated group and 2.1 ± 1.7 for controls. Rejection episodes with IFN-α treatment were mild and responded to steroid therapy. In OLT recipients, the risk of acute rejection was not increased by the introduction of IFN-α. However, in this study, patients were exposed to greater levels of immunosuppression.

Original languageEnglish (US)
Pages (from-to)197-203
Number of pages7
JournalLiver Transplantation and Surgery
Volume4
Issue number3
StatePublished - 1998
Externally publishedYes

Fingerprint

interferon alfa-2b
Interferon-alpha
Allografts
Liver
Incidence
Tacrolimus
Immunosuppression
Cyclosporine
Transplant Recipients
Prednisone
Therapeutics
Hepatitis

ASJC Scopus subject areas

  • Hepatology
  • Surgery

Cite this

Jain, A., Demetris, A. J., Manez, R., Tsamanadas, A. C., Van Thiel, D., Rakela, J., ... Fung, J. J. (1998). Incidence and severity of acute allograft rejection in liver transplant recipients treated with alfa interferon. Liver Transplantation and Surgery, 4(3), 197-203.

Incidence and severity of acute allograft rejection in liver transplant recipients treated with alfa interferon. / Jain, A.; Demetris, A. J.; Manez, R.; Tsamanadas, A. C.; Van Thiel, D.; Rakela, Jorge; Starzl, T. E.; Fung, J. J.

In: Liver Transplantation and Surgery, Vol. 4, No. 3, 1998, p. 197-203.

Research output: Contribution to journalArticle

Jain, A, Demetris, AJ, Manez, R, Tsamanadas, AC, Van Thiel, D, Rakela, J, Starzl, TE & Fung, JJ 1998, 'Incidence and severity of acute allograft rejection in liver transplant recipients treated with alfa interferon', Liver Transplantation and Surgery, vol. 4, no. 3, pp. 197-203.
Jain, A. ; Demetris, A. J. ; Manez, R. ; Tsamanadas, A. C. ; Van Thiel, D. ; Rakela, Jorge ; Starzl, T. E. ; Fung, J. J. / Incidence and severity of acute allograft rejection in liver transplant recipients treated with alfa interferon. In: Liver Transplantation and Surgery. 1998 ; Vol. 4, No. 3. pp. 197-203.
@article{dc432392dc7545aa881b3479c02b8a7c,
title = "Incidence and severity of acute allograft rejection in liver transplant recipients treated with alfa interferon",
abstract = "Interferon alfa-2b (IFN-α) therapy has been shown to be effective in the treatment of viral hepatitis B (HBV) or viral hepatitis C (HCV) in patients who did not undergo transplantation. However, in allograft recipients, treatment with IFN-α often leads to allograft rejection. The aim of the present study was to determine if IFN-α therapy increases the incidence or severity of acute rejection in human liver allograft recipients. One hundred five orthotopic liver transplant (OLT) recipients with HBV (n = 32), HCV (n = 58), or Non A Non B Non C (n = 15) viral infections were treated with a 6-month course of IFN-α, 5 million U subcutaneously three times a week, which began 2 to 97 months after transplantation. The mean hepatitis activity index (HAI) at the beginning of the therapy was 10.1 ± 3.0. The baseline immunosuppression was achieved by tacrolimus in 77 patients and by cyclosporine A (CyA) in 28 patients. Contemporaneous controls consisted of 132 OLT patients (100 who received tacrolimus and 32 who received CyA) who did not receive IFN-α. A retrospective analysis was performed on this group of patients. The incidence of rejection and the baseline immunosuppression were compared. All biopsies were reviewed without knowledge of clinical data and scored for HAI and for rejection activity index (RAI). The biochemical response to IFN-α was also examined. The mean baseline maintenance dose of prednisone was greater by 2 mg daily in patients who received IFN-α with tacrolimus compared with control patients who did not receive IFN-α with tacrolimus (IFN-α 5.3 ± 5.2 mg daily v controls 3.3 ± 4.9 mg daily; P ≤ .05). Similarly, the mean maintenance dose of prednisone was greater by 2.5 mg daily in patients who received IFN-α compared with controls who received CyA-based immunosuppression (IFN-α 9.8 ± 3.1 mg daily v controls 7.3 ± 3.3 mg daily; P = .01). Acute rejection episodes were detected in 10.5{\%} (n = 11) of IFN-α-treated patients compared with 8.8{\%} of controls for the similar time period from OLT and period of exposure to risk of rejection. Mean RAI was 2.0 ± 2.4 for the IFN-α- treated group and 2.1 ± 1.7 for controls. Rejection episodes with IFN-α treatment were mild and responded to steroid therapy. In OLT recipients, the risk of acute rejection was not increased by the introduction of IFN-α. However, in this study, patients were exposed to greater levels of immunosuppression.",
author = "A. Jain and Demetris, {A. J.} and R. Manez and Tsamanadas, {A. C.} and {Van Thiel}, D. and Jorge Rakela and Starzl, {T. E.} and Fung, {J. J.}",
year = "1998",
language = "English (US)",
volume = "4",
pages = "197--203",
journal = "Liver Transplantation",
issn = "1527-6465",
publisher = "John Wiley and Sons Ltd",
number = "3",

}

TY - JOUR

T1 - Incidence and severity of acute allograft rejection in liver transplant recipients treated with alfa interferon

AU - Jain, A.

AU - Demetris, A. J.

AU - Manez, R.

AU - Tsamanadas, A. C.

AU - Van Thiel, D.

AU - Rakela, Jorge

AU - Starzl, T. E.

AU - Fung, J. J.

PY - 1998

Y1 - 1998

N2 - Interferon alfa-2b (IFN-α) therapy has been shown to be effective in the treatment of viral hepatitis B (HBV) or viral hepatitis C (HCV) in patients who did not undergo transplantation. However, in allograft recipients, treatment with IFN-α often leads to allograft rejection. The aim of the present study was to determine if IFN-α therapy increases the incidence or severity of acute rejection in human liver allograft recipients. One hundred five orthotopic liver transplant (OLT) recipients with HBV (n = 32), HCV (n = 58), or Non A Non B Non C (n = 15) viral infections were treated with a 6-month course of IFN-α, 5 million U subcutaneously three times a week, which began 2 to 97 months after transplantation. The mean hepatitis activity index (HAI) at the beginning of the therapy was 10.1 ± 3.0. The baseline immunosuppression was achieved by tacrolimus in 77 patients and by cyclosporine A (CyA) in 28 patients. Contemporaneous controls consisted of 132 OLT patients (100 who received tacrolimus and 32 who received CyA) who did not receive IFN-α. A retrospective analysis was performed on this group of patients. The incidence of rejection and the baseline immunosuppression were compared. All biopsies were reviewed without knowledge of clinical data and scored for HAI and for rejection activity index (RAI). The biochemical response to IFN-α was also examined. The mean baseline maintenance dose of prednisone was greater by 2 mg daily in patients who received IFN-α with tacrolimus compared with control patients who did not receive IFN-α with tacrolimus (IFN-α 5.3 ± 5.2 mg daily v controls 3.3 ± 4.9 mg daily; P ≤ .05). Similarly, the mean maintenance dose of prednisone was greater by 2.5 mg daily in patients who received IFN-α compared with controls who received CyA-based immunosuppression (IFN-α 9.8 ± 3.1 mg daily v controls 7.3 ± 3.3 mg daily; P = .01). Acute rejection episodes were detected in 10.5% (n = 11) of IFN-α-treated patients compared with 8.8% of controls for the similar time period from OLT and period of exposure to risk of rejection. Mean RAI was 2.0 ± 2.4 for the IFN-α- treated group and 2.1 ± 1.7 for controls. Rejection episodes with IFN-α treatment were mild and responded to steroid therapy. In OLT recipients, the risk of acute rejection was not increased by the introduction of IFN-α. However, in this study, patients were exposed to greater levels of immunosuppression.

AB - Interferon alfa-2b (IFN-α) therapy has been shown to be effective in the treatment of viral hepatitis B (HBV) or viral hepatitis C (HCV) in patients who did not undergo transplantation. However, in allograft recipients, treatment with IFN-α often leads to allograft rejection. The aim of the present study was to determine if IFN-α therapy increases the incidence or severity of acute rejection in human liver allograft recipients. One hundred five orthotopic liver transplant (OLT) recipients with HBV (n = 32), HCV (n = 58), or Non A Non B Non C (n = 15) viral infections were treated with a 6-month course of IFN-α, 5 million U subcutaneously three times a week, which began 2 to 97 months after transplantation. The mean hepatitis activity index (HAI) at the beginning of the therapy was 10.1 ± 3.0. The baseline immunosuppression was achieved by tacrolimus in 77 patients and by cyclosporine A (CyA) in 28 patients. Contemporaneous controls consisted of 132 OLT patients (100 who received tacrolimus and 32 who received CyA) who did not receive IFN-α. A retrospective analysis was performed on this group of patients. The incidence of rejection and the baseline immunosuppression were compared. All biopsies were reviewed without knowledge of clinical data and scored for HAI and for rejection activity index (RAI). The biochemical response to IFN-α was also examined. The mean baseline maintenance dose of prednisone was greater by 2 mg daily in patients who received IFN-α with tacrolimus compared with control patients who did not receive IFN-α with tacrolimus (IFN-α 5.3 ± 5.2 mg daily v controls 3.3 ± 4.9 mg daily; P ≤ .05). Similarly, the mean maintenance dose of prednisone was greater by 2.5 mg daily in patients who received IFN-α compared with controls who received CyA-based immunosuppression (IFN-α 9.8 ± 3.1 mg daily v controls 7.3 ± 3.3 mg daily; P = .01). Acute rejection episodes were detected in 10.5% (n = 11) of IFN-α-treated patients compared with 8.8% of controls for the similar time period from OLT and period of exposure to risk of rejection. Mean RAI was 2.0 ± 2.4 for the IFN-α- treated group and 2.1 ± 1.7 for controls. Rejection episodes with IFN-α treatment were mild and responded to steroid therapy. In OLT recipients, the risk of acute rejection was not increased by the introduction of IFN-α. However, in this study, patients were exposed to greater levels of immunosuppression.

UR - http://www.scopus.com/inward/record.url?scp=0031968969&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031968969&partnerID=8YFLogxK

M3 - Article

C2 - 9563957

AN - SCOPUS:0031968969

VL - 4

SP - 197

EP - 203

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1527-6465

IS - 3

ER -