INCIDENCE OF REJECTION AND INFECTION AFTER LIVER-TRANSPLANTATION AS AFUNCTION OF THE PRIMARY DISEASE - POSSIBLE INFLUENCE OF ALCOHOL AND POLYCLONAL IMMUNOGLOBULINS

A retrospective analysis was undertaken to determine if the incidence, timing, and severity of acute and chronic rejection were influenced b y the primary disease necessitating transplantation. Of the 875 liver transplantations performed between 1984 and 1992, 768 were primary tra nsplantations and 107 were retransplantations. Among the former, 330 p atients that were liver transplant recipients for a chronic liver dise ase without cancer in the native liver received an ABO-compatible and cross-match-negative graft and were given a cyclosporine- or tacrolimu s-based immunosuppression. These included primary biliary cirrhosis (P BC, 66 patients), primary sclerosing cholangitis (PSC, 23 patients), a lcoholic cirrhosis (ALC, 21 patients), autoimmune cirrhosis (AIC, 17 p atients), hepatitis B virus-induced cirrhosis (HBV-C, 116 patients) an d hepatitis C virus-induced cirrhosis (HCV-C, 87 patients). The incide nce of acute (48% +/- 3% [SE] at 1 year) and chronic rejection (10% +/ - 2% at 3 years) was comparable in patients who have undergone transpl antation for PBC, PSC, AIC, and HCV-C. However, the incidence of acute (but not chronic) rejection was significantly lower in patients who h ave undergone transplantation for ALC (29% at 1 year). This reduced in cidence of acute rejection was associated with an increased incidence of bacterial infections. In patients who have undergone transplantatio n for HBV-C (the majority of whom had received longterm anti-hepatitis B surface antigen [HBs] immunoglobulins), the incidence of both acute (21% at 1 year) and chronic rejection (0% at 3 years) was significant ly lower, whereas the incidence of septic complications was comparable with that in the other groups. The incidence of acute rejection in pa tients who have undergone transplantation for nonviral disease receivi ng polyclonal human anti-cytomegalovirus (CMV) immunoglobulins was als o significantly lower than that of patients who did not receive the im munoglobulins (19% vs. 48% at 3 months; P = .01), and this was identic al to that of patients who have undergone transplantation for viral di sease receiving polyclonal human anti-HBs immunoglobulins (19% at 3 mo nths). These results show that the risk of rejection is unequal among patients, being lower in patients who have undergone transplantation f or ALC (probably as a result of a state of nonspecific hyporesponsiven ess) and in patients who have undergone transplantation for HBV-C (pos sibly as a result of longterm administration of polyclonal human immun oglobulins).