Roberts Amin J, Lim Alicia, Bishop Jonathan R, Gane Ed, Rakhmanova Elizaveta, Wong William, Evans Helen M
Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand.
Department of Paediatrics, University of Auckland, Auckland, New Zealand.
J Paediatr Child Health. 2023 Mar;59(3):537-541. doi: 10.1111/jpc.16349. Epub 2023 Jan 30.
There are increasing reports of atopy/allergy following solid organ transplantation, especially paediatric liver transplantation (LT) with minimal New Zealand (NZ) data. We describe the prevalence of transplant-acquired atopy and allergy (TAA) in NZ paediatric liver transplant recipients, compared to paediatric kidney and adult liver transplants.
TAA focussed health questionnaires were sent to patients selected from the NZ transplant registry (transplanted between January 2003 and December 2017). Demographic and clinical data were also obtained from electronic health records and follow-up phone calls.
A total of 232 patients (62% male) participated (111 adult liver, 82 paediatric liver, 39 paediatric kidney transplant recipients). Tacrolimus was primary immunosuppression for all LT patients; with combined tacrolimus, mycophenolate and corticosteroids for kidney transplants. The number of patients who developed TAA was significantly higher (P < 0.001) in the paediatric LT group (36/82, 44%) compared to adult liver (12/111, 11%) and paediatric kidney transplants (4/39, 10%). Eczema was most common (73%), then IgE-mediated food allergy (FA, 33%), allergic rhinitis (19%) and asthma (17%). Six paediatric LT recipients developed eosinophilic oesophagitis (EoE). Egg was the most common allergen in the IgE-mediated FA group. TAAs were severe enough to warrant a switch from tacrolimus to another agent in seven paediatric LT patients. For paediatric LT patients, female gender and younger age at transplant were risk factors for developing TAA.
TAA is common in paediatric liver transplant recipients, with female gender and younger age at transplant being risk factors identified. This highlights the need for detailed atopic and allergy history to be incorporated in all pre-transplant assessments.
实体器官移植后出现特应性/过敏的报道日益增多，尤其是小儿肝移植（LT），而新西兰（NZ）相关数据极少。我们描述了新西兰小儿肝移植受者中移植获得性特应性和过敏（TAA）的患病率，并与小儿肾移植和成人肝移植受者进行比较。
向从NZ移植登记处选取的患者（2003年1月至2017年12月期间接受移植）发送聚焦于TAA的健康问卷。还从电子健康记录和随访电话中获取人口统计学和临床数据。
共有232名患者（62%为男性）参与（111名成人肝移植、82名小儿肝移植、39名小儿肾移植受者）。他克莫司是所有肝移植患者的主要免疫抑制剂；肾移植患者联合使用他克莫司、霉酚酸酯和皮质类固醇。小儿肝移植组发生TAA的患者数量（36/82，44%）显著高于成人肝移植组（12/111，11%）和小儿肾移植组（4/39，10%）（P<0.001）。湿疹最为常见（73%），其次是IgE介导的食物过敏（FA，33%）、过敏性鼻炎（19%）和哮喘（17%）。6名小儿肝移植受者发生了嗜酸性粒细胞性食管炎（EoE）。在IgE介导的FA组中，鸡蛋是最常见的过敏原。7名小儿肝移植患者的TAA严重到需要从他克莫司换用另一种药物。对于小儿肝移植患者，女性性别和移植时年龄较小是发生TAA的危险因素。
TAA在小儿肝移植受者中很常见，已确定女性性别和移植时年龄较小是危险因素。这突出表明在所有移植前评估中都需要纳入详细的特应性和过敏史。
