RESULTS OF TRANSPLANTATION FOR ACUTE AND CHRONIC HEPATIC ALLOGRAFT-REJECTION

Background/Purpose: Transplantation for rejection is a requirement in liver transplant recipients when allograft failure is imminent. The au thors evaluated the outcome of these children and their allografts. Me thods: The medical records of 129 children who received a liver transp lant were reviewed retrospectively. Twelve children required transplan tation for biopsy-proven rejection-10 chronic and two acute. Overall p atient and graft survival were compared with children receiving primar y liver transplants. The current allograft function of the patients un dergoing transplants was also reviewed. Statistical significance was d etermined by Fisher's Exact test. Results: Twelve children received at least one retransplant for biopsy-proven rejection. Graft survival at 1 year was 58% (v 79% for primary transplants) and patient survival w as 83% (vs 89%). Two allografts were lost because of primary allograft nonfunction. Three additional allografts were lost-two to recurrent r ejection and one to hepatic artery thrombosis. Two patients who lost a second transplant to rejection required a total of seven transplants to treat rejection. Two children died, one of primary nonfunction and one of adenovirus pneumonia. The 10 surviving patients all have excell ent graft function (total bilirubin, 0.74 +/- 0.38, aspartate aminotra nsferase, 40 +/- 22). Conclusion:These data suggest that transplantati on for rejection can be accomplished safely with a patient survival ra te comparable to primary liver transplantation; however, graft loss is excessive and underscores the need for more adequate immunosuppressio n. J Pediatr Surg 33:909-912. Copyright (C) 1998 by W.B. Saunders Comp any.