The introduction of the immunosuppressive agent, tacrolimus, has led to a significant reduction in acute rejection of liver transplants. However, little is known about the rate of chronic rejection for liver transplant patients taking tacrolimus.
Dr Ashok Jain and colleagues in Pittsburgh, USA, evaluated the development of chronic rejection in 1,048 consecutive adults receiving primary liver allografts.
After a mean follow up of 77.3 months 32 of the 1,048 patients (3.1%) developed chronic rejection.
Patients were divided into 3 groups in order to assess the risk of chronic rejection depending on primary diagnosis.
|Predictors of chronic rejection:|
Hep B/Hep C induced cirrhosis
PBC, PSC or AIH
Mean donor age
Group 1 contained patients with hepatitis B or hepatitis C induced cirrhosis. Group 2 included patients with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) or autoimmune hepatitis (AIH). Patients with other diagnoses were placed in group 3.
The researchers found that patients in group 2 were 3.2 times more likely to develop chronic rejection than patients in group 3 and 1.3 times as likely as patients in group 1.
Increased donor age and the incidence of acute rejection also raised the likelihood of chronic rejection.