LACK OF CORRELATION BETWEEN THE MAGNITUDE OF PRESERVATION INJURY AND THE INCIDENCE OF ACUTE REJECTION, NEED FOR OKT3, AND CONVERSION TO FK506 IN CYCLOSPORINE-TREATED PRIMARY LIVER ALLOGRAFT RECIPIENTS

In order to study further whether a relationship exists between the ex tent of ischemia-preservation-reperfusion injury (IPRI) and acute reje ction (AR) events in liver allografts, we retrospectively reviewed 213 consecutive cyclosporine-treated patients who received their first li ver allograft between 1/1/93 and 12/31/93. Of these, 178 fulfilled the study inclusion criteria, The extent of IPRI was assessed by the peak value of aspartate aminotransferase (ASTmax) observed within the firs t 72 hr posttransplant. For the purpose of univariate analysis, catego rical classification of recipients was done based upon ASTmax as follo ws: group 1, ASTmax < 600 IU/L (n=43); group 2, ASTmax 600-2000 IU/L ( n=86); and group 3, ASTmax >2000 IU/L (n=49). For multivariate analysi s, stepwise Cox regression was performed with age, ASTmax, and UNOS st atus as covariates. At a median follow-up of 271 days there were no st atistically significant differences between groups with respect to the incidence of a first episode of AR (47%, 55%, 51%, respectively, P=NS ), the timing of AR (respective medians, 9, 10, and 10 days, P=NS), or the proportion of patients treated with OKT3 (9%, 20%, 12%, respectiv ely, P=NS) or converted to FK506 (16%, 12%, 10%, P=NS). Cox regression confirmed the lack of an independent association between the extent o f IPRI and any of these outcomes. We conclude that in UW-preserved, cy closporine-treated primary liver allografts, no correlation exists bet ween the extent of IPRI and the incidence, timing, severity, or refrac toriness of clinically defined AR events.