Primary liver disease as a determinant for acute rejection after liver transplantation

Background: Graft rejection and infection remain major problems following l iver transplantation; both are heavily influenced by the immunosuppressive regimen. Despite the disparity in the primary disease leading to transplant ation, all patients receive the same posttransplant immunosuppressive treat ment in a given center. The aim of this study is to detect a possible effec t of the underlying disease on the incidence of early acute rejection episo des after orthotopic liver transplantation (OLT). Patients and Methods: Ret rospective analysis on all 101 consecutive liver transplants performed in 9 5 patients between 1983 and March 1998; five of these patients, surviving l ess than 30 days, were not included. The immunosuppressive regimen was base d on conventional triple therapy during the whole study period. The diagnos is and treatment of acute rejection within the first 30 days post-OLT was u niform throughout the whole study period. Results: Though there were no dif ferences with respect to patients' characteristics [age, child classificati on, number of HLA-mismatches or cytomegalovirus (CMV)serocompatibility], pa tients with primary biliary cirrhosis (PBC) showed a significant increase o f acute rejection after OLT compared with the other patients transplanted f or other liver diseases (P = 0.024). The incidence of infection was not ele vated in patients transplanted for PBC when compared with other diagnoses. Conclusion: Our results indicate that primary liver disease may be a determ inant for acute graft rejection in PBC. Furthermore, these results suggest that immunosuppressive regimens based on the underlying disease should be c onsidered.