Choudhary Narendra Singh, Saraf Neeraj, Saigal Sanjiv, Gautam Dheeraj, Rastogi Amit, Goja Sanjay, Bhangui Prashant, Srinivasan Thiagrajan, Yadav Sanjay Kumar, Soin Arvinder
Institute of Liver Transplantation and Regenerative Medicine, Medanta, The Medicity, Gurgaon, India.
Department of Histopathology, Medanta, The Medicity, Gurgaon, India.
Clin Transplant. 2018 Feb;32(2). doi: 10.1111/ctr.13161.
Chronic rejection (CR) is an uncommon but important cause of graft dysfunction, leading to graft loss and often requires retransplantation. This study evaluates the incidence and outcome of the patients with CR at a large living donor liver transplant (LDLT) center.
Data of patients with CR were retrospectively analyzed in 1232 adult (age >18 years) LDLT on tacrolimus (mainly)-based immunosuppression. Sirolimus/everolimus (mammalian target of rapamycin [mTOR] inhibitors) was added to baseline immunosuppression as rescue therapy in patients with CR. Data are shown as median (interquartile range [IQR]).
Twenty-three patients (22 males), aged 42 (IQR 45-56) years, had biopsy-proven chronic rejection at 21 (8-44) months after liver transplantation. The incidence of chronic rejection was 1.9% in this cohort. The patients with CR (n = 23) had a significantly higher incidence of cytomegalovirus (CMV) viremia, acute cellular rejection, and history of anastomotic biliary strictures as compared to patients without CR. Five patients were noncompliant with immunosuppression before the diagnosis of CR. Twelve patients (52%) responded to addition of mTOR inhibitors, whereas 11 did not respond and had poor outcome.
The incidence of chronic rejection is low in LDLT. Treatment with mTOR inhibitors can reverse graft dysfunction in approximately half of the patients.
慢性排斥反应（CR）是移植器官功能障碍的一个不常见但重要的原因，可导致移植器官丧失，且常常需要再次移植。本研究评估了一家大型活体供肝移植（LDLT）中心CR患者的发生率及预后情况。
对1232例接受以他克莫司（主要药物）为基础的免疫抑制治疗的成年（年龄>18岁）LDLT患者中CR患者的数据进行回顾性分析。对于CR患者，在基线免疫抑制治疗基础上加用西罗莫司/依维莫司（雷帕霉素靶蛋白[mTOR]抑制剂）作为挽救治疗。数据以中位数（四分位间距[IQR]）表示。
23例患者（22例男性），年龄42（IQR 45 - 56）岁，在肝移植后21（8 - 44）个月经活检证实发生慢性排斥反应。该队列中慢性排斥反应的发生率为1.9%。与无CR的患者相比，CR患者（n = 23）的巨细胞病毒（CMV）病毒血症、急性细胞排斥反应及吻合口胆管狭窄病史的发生率显著更高。5例患者在CR诊断前存在免疫抑制治疗依从性差的情况。12例患者（52%）对加用mTOR抑制剂有反应，而11例患者无反应且预后较差。
LDLT中慢性排斥反应的发生率较低。mTOR抑制剂治疗可使大约一半的患者移植器官功能障碍得到逆转。
