ABSTRACT
Rejection is the most usual cause of primary dysfunction of hepatic allograft transplants. Acute rejection (AR) often occurs in the early post-transplantation weeks, with an incidence of 12%-19%. Chronic rejection (CR) is less usual (2.5%-17%) and irreversible. Our aim was to determine the incidence of AR and CR in patients who underwent transplantaton due to alcoholism-induced cirrhosis and the survival of these groups. We undertook a retrospective study of the 93 patients who received a liver transplant due to hepatic cirrhosis between 2005 and 2012. AR occurred in 23.7% of cases, and CR in 11.8%. The median time from implantation to the appearance of AR was 34.5 days, and for CR it was 334 days. The survival of the patients with AR and CR showed no significant differences as compared with the control group (P = .77). From our clinical appraisal, symptoms of previous AR may lead to CR, although the relationship was not significant.
Subject(s)
Graft Rejection/epidemiology , Liver Cirrhosis, Alcoholic/surgery , Liver Transplantation/adverse effects , Acute Disease , Biopsy , Chronic Disease , Female , Graft Rejection/diagnosis , Graft Rejection/mortality , Graft Survival , Humans , Incidence , Kaplan-Meier Estimate , Liver Cirrhosis, Alcoholic/diagnosis , Liver Cirrhosis, Alcoholic/mortality , Liver Transplantation/mortality , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Risk Factors , Spain/epidemiology , Time Factors , Treatment OutcomeABSTRACT
AIMS: To report our experience with mycophenolate mofetil (MMF) for induction and maintenance therapy to prevent acute liver transplant rejection. METHODS: A retrospective analysis of 66 elective, noncombined liver transplant patients treated beginning de novo MMF and follow for a minimum of 2 years. Thirty-nine of the 66 cases received MMF, calcineurin inhibitors, and steroids. In 11 cases daclizumab was added; in 16 daclizumab was added without steroids. RESULTS: The global survival rate was 91% at 6 months, 89.4% at 1 year, and 87.9% after 2 years. Acute rejection episodes were observed in six patients (9.1%). All episodes responded to corticoids. Toxicity possibly, probably, or partially related to MMF was observed in 35 patients (53%) with definitive suspension required in 13 cases (20%), with dose reduction or temporary suspension in 22 (33%). Hematological toxicity associated with MMF was observed in 12 patients (18%), leading to definitive suspension in two patients (3.03%), temporary suspension in two cases (3.03%), and dose reduction in eight cases (12%). Opportunistic infection was observed in seven cases (10%). Gastrointestinal toxicity was mild and infrequent (five cases, 7.5%). CONCLUSION: Regimens containing MMF reduce rejection episodes with high survival rates and low toxicity.
