Prognostic factors for the evolution and reversibility of chronic rejection in pediatric liver transplantation
OBJECTIVE: Chronic rejection remains a major cause of graft failure with indication for re-transplantation. The incidence of chronic rejection remains high in the pediatric population. Although several risk factors have been implicated in adults, the prognostic factors for the evolution and reversib...
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Faculdade de Medicina / USP
2016-04-01
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doaj-247f8e93e526411997095cd48240645a2020-11-24T21:29:56ZengFaculdade de Medicina / USPClinics1980-53222016-04-0171421622010.6061/clinics/2016(04)07S1807-59322016000400216Prognostic factors for the evolution and reversibility of chronic rejection in pediatric liver transplantationAna Cristina Aoun TannuriFabiana LimaEvandro Sobroza de MelloRyan Yukimatsu TanigawaUenis TannuriOBJECTIVE: Chronic rejection remains a major cause of graft failure with indication for re-transplantation. The incidence of chronic rejection remains high in the pediatric population. Although several risk factors have been implicated in adults, the prognostic factors for the evolution and reversibility of chronic rejection in pediatric liver transplantation are not known. Hence, the current study aimed to determine the factors involved in the progression or reversibility of pediatric chronic rejection by evaluating a series of chronic rejection cases following liver transplantation. METHODS: Chronic rejection cases were identified by performing liver biopsies on patients based on clinical suspicion. Treatment included maintaining high levels of tacrolimus and the introduction of mofetil mycophenolate. The children were divided into 2 groups: those with favorable outcomes and those with adverse outcomes. Multivariate analysis was performed to identify potential risk factors in these groups. RESULTS: Among 537 children subjected to liver transplantation, chronic rejection occurred in 29 patients (5.4%). In 10 patients (10/29, 34.5%), remission of chronic rejection was achieved with immunosuppression (favorable outcomes group). In the remaining 19 patients (19/29, 65.5%), rejection could not be controlled (adverse outcomes group) and resulted in re-transplantation (7 patients, 24.1%) or death (12 patients, 41.4%). Statistical analysis showed that the presence of ductopenia was associated with worse outcomes (risk ratio=2.08, p=0.01). CONCLUSION: The presence of ductopenia is associated with poor prognosis in pediatric patients with chronic graft rejection.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322016000400216&lng=en&tlng=enChronic RejectionCyclosporinePediatric Liver TransplantationTacrolimusRejectionMycophenolate Mofetil |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ana Cristina Aoun Tannuri Fabiana Lima Evandro Sobroza de Mello Ryan Yukimatsu Tanigawa Uenis Tannuri |
spellingShingle |
Ana Cristina Aoun Tannuri Fabiana Lima Evandro Sobroza de Mello Ryan Yukimatsu Tanigawa Uenis Tannuri Prognostic factors for the evolution and reversibility of chronic rejection in pediatric liver transplantation Clinics Chronic Rejection Cyclosporine Pediatric Liver Transplantation Tacrolimus Rejection Mycophenolate Mofetil |
author_facet |
Ana Cristina Aoun Tannuri Fabiana Lima Evandro Sobroza de Mello Ryan Yukimatsu Tanigawa Uenis Tannuri |
author_sort |
Ana Cristina Aoun Tannuri |
title |
Prognostic factors for the evolution and reversibility of chronic rejection in pediatric liver transplantation |
title_short |
Prognostic factors for the evolution and reversibility of chronic rejection in pediatric liver transplantation |
title_full |
Prognostic factors for the evolution and reversibility of chronic rejection in pediatric liver transplantation |
title_fullStr |
Prognostic factors for the evolution and reversibility of chronic rejection in pediatric liver transplantation |
title_full_unstemmed |
Prognostic factors for the evolution and reversibility of chronic rejection in pediatric liver transplantation |
title_sort |
prognostic factors for the evolution and reversibility of chronic rejection in pediatric liver transplantation |
publisher |
Faculdade de Medicina / USP |
series |
Clinics |
issn |
1980-5322 |
publishDate |
2016-04-01 |
description |
OBJECTIVE: Chronic rejection remains a major cause of graft failure with indication for re-transplantation. The incidence of chronic rejection remains high in the pediatric population. Although several risk factors have been implicated in adults, the prognostic factors for the evolution and reversibility of chronic rejection in pediatric liver transplantation are not known. Hence, the current study aimed to determine the factors involved in the progression or reversibility of pediatric chronic rejection by evaluating a series of chronic rejection cases following liver transplantation. METHODS: Chronic rejection cases were identified by performing liver biopsies on patients based on clinical suspicion. Treatment included maintaining high levels of tacrolimus and the introduction of mofetil mycophenolate. The children were divided into 2 groups: those with favorable outcomes and those with adverse outcomes. Multivariate analysis was performed to identify potential risk factors in these groups. RESULTS: Among 537 children subjected to liver transplantation, chronic rejection occurred in 29 patients (5.4%). In 10 patients (10/29, 34.5%), remission of chronic rejection was achieved with immunosuppression (favorable outcomes group). In the remaining 19 patients (19/29, 65.5%), rejection could not be controlled (adverse outcomes group) and resulted in re-transplantation (7 patients, 24.1%) or death (12 patients, 41.4%). Statistical analysis showed that the presence of ductopenia was associated with worse outcomes (risk ratio=2.08, p=0.01). CONCLUSION: The presence of ductopenia is associated with poor prognosis in pediatric patients with chronic graft rejection. |
topic |
Chronic Rejection Cyclosporine Pediatric Liver Transplantation Tacrolimus Rejection Mycophenolate Mofetil |
url |
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322016000400216&lng=en&tlng=en |
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