Predictive factors for portal fibrosis in pediatric liver transplant recipients

Background, Recent histopathological studies showed an unexpected high inci dence of pathological changes in asymptomatic survivors after pediatric liv er transplantation. The aim of this study was to analyze the occurrence of histological abnormalities, to assess the clinical significance, and to ide ntify predictive factors for these pathological changes, Methods, The first annual protocol graft biopsies of 84 consecutive liver t ransplants were analyzed and correlated with concomitant liver function tes ts. Identification of predictive factors for the histological abnormalities in the biopsies was performed by a multivariate logistic regression analys is. Results. The incidence of portal fibrosis (PF) was 31%, Liver function test s showed except for the albumin level, an increase in the PF group compared with the group without PF. Mean values of alkaline phosphatase and direct bilirubin were 264 U/liter and 3 mu mol/liter, respectively, in the normal group, and 435 U/liter and 23 mu mol/liter, respectively, in the PF group ( P=0,043 and 0,037), Eight of 19 univariantly tested variables were entered into a logistic regression model: cold ischemia time, preservation solution , type of allograft, cytomegalovirus recipient status, type of biliary reco nstruction, biliary complications, graft complications, and rejection, A si gnificant positive correlation with PF was found for cold ischemia time, bi liary complications, and cytomegalovirus status, Acute rejection showed a n egative correlation. Conclusions. The incidence of PF within 1 year post liver transplantation w as 31%, This finding was accompanied by cholestatic liver function test abn ormalities. Factors predisposing to PP were a prolonged cold ischemia time, biliary complications, and a positive cytomegalovirus recipient status. Ac ute rejection seemed to prevent for PF.