Living related liver transplantation: Histopathologic analysis of graft dysfunction in 304 patients

Between June 1990 and August 1997, 304 mainly pediatric patients underwent a total of 311 orthotopic living related liver transplantations (LRLTs) und er tacrolimus immunosuppression at Kyoto University Hospital. Congenital bi liary atresia was the most common underlying disease. The donor was a paren t, and the left lateral segments were used as grafts in most cases. The ave rage number of loci of HLA-A, -B, and -DR mismatches between the donor and the recipient were 2.1. Forty-three transplants were ABO-incompatible. Live r histology at the time of abnormal liver function after transplantation wa s analyzed. Preservation injury was rare and mild. Acute cellular rejection (ACR) occurred in 36% of transplants during the first 6 months. Average re jection activity index (the Banff schema) was 4.2 and severe rejection was rarely seen. The number of mismatching HLA loci and immunosuppression regim ens affected the incidence of ACR. Chronic rejection (CR) occurred in 2% of transplants. Concerning humoral rejection, no hyperacute rejection was see n. However, hepatic artery thrombosis (delayed hyperacute rejection) was se en in an ABO-incompatible transplant. Acute hepatitis, including those rela ted to cytomegalovirus and Epstein-Barr virus, occurred in 17% of transplan ts. Chronic hepatitis, including hepatitis B and C, developed in 3%. Acute or chronic cholangitis occurred in 16%, and a significantly higher incidenc e of cholangitis was found in ABO-incompatible transplants. Posttransplanta tion lymphoproliferative disease developed in 2%. In LRLT, milder preservat ion injury and less frequent ACR and CR were suggested, probably because of the short cold-ischemia time and the advantages of HLA histocompatibility, respectively. Copyright (C) 1999 by W.B. Saunders Company.