Persistent donor-specific alloreactivity may portend delayed liver rejection during drug minimization in children

Nandita Khera, Janine Janosky, Adriana Zeevi, George Mazariegos, Amadeo Marcos, Rakesh Sindhi

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

Immunoreactivity, immunosuppression requirement and liver graft function was assessed serially for its relationship to delayed/recurrent acute cellular rejection (ACR) after the first 60 days in 36 pediatric primary liver transplant (LTx) recipients. Subjects were classified as rejectors (n=20) or Non-Rejectors (n=16) based on the presence/absence of biopsy-proven ACR in the first 60 days. All children recieved anti-lymphocyte induction and steroid-free Tacrolimus or Sirolimus monotherapy, as reported previously. Median age was 4 years (0.45-18) and follow-up was 570 days (106-1144). Compared with nonrejectors, rejectors 1. took significantly longer to achieve reduced donor-specific alloreactivity by MLR (p=0.049), and "low" TAC/SRL whole blood requirements defined as TAC levels ≥8 ng/ml (p=0.0048), 2. experienced significantly greater variation in time to achieve reduced donor-specific immunoreactivity (SEM 0.8 vs 3.85, p=0.0048), and 3. experienced greater ACR incidence during minimization of immunosuppression (35% versus 6%, p=0.032). Serial monitoring of immunoreactivity may increase the safety with which immunosuppression is minimized in pediatric LTx.

Original languageEnglish (US)
Pages (from-to)660-663
Number of pages4
JournalFrontiers in Bioscience
Volume12
Issue number2
DOIs
StatePublished - Jun 7 2007

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Keywords

  • Delayed
  • Drug
  • Immunoreactivity
  • Minimization
  • Recurrent
  • Rejection
  • Review
  • Risk

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Microbiology(all)

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