Effect of immunosuppressive regimen on acute rejection and liver graft function

Transplant Proc. 2003 Sep;35(6):2281-3. doi: 10.1016/s0041-1345(03)00794-2.

Abstract

Despite the use of modern immunosuppressive drugs, acute liver rejection (AR) continues to affect up to 70% of transplant recipients. The aim of this retrospective study was to assess the incidence of acute rejection episodes in patients treated with different immunosuppressive protocols. In our series, 37.3% of patients developed a clinical episode of AR. Analysis of immunosuppression has shown that the most effective immunosuppressive protocols, with regard to prevention of AR, include: antibody anti-IL-2R (anti-IL-2R) + tacrolimus (Tac) + mycophenolate mofetil (MMF) + prednisolone (Pred); anti-IL-2R + tacrolimus (Tac) + Pred; or Tac + Pred (25% vs 28.6% vs 30.4%, respectively). The highest rate of AR (66.6%) was observed among patients with anti-IL-2R and Tac but no steroid treatment, mostly (77.7%) in the initial period after liver transplantation. There were no statistical differences in liver function tests between the group treated with a CsA-based versus a Tac-based therapy. Strong immunosuppression contributed to a relatively low incidence of clinical AR in our series. The lowest rate of AR was observed among patients treated with anti-IL-2R antibody. Tac, and Pred. Deprivation of steroids in the early phase after liver transplantation substantially increased the risk of acute rejection episodes despite the use of anti-CD25. There were no statistically significant differences in liver function tests among those treated with Tac versus CsA in the short-term follow-up.

MeSH terms

  • Acute Disease
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized
  • Basiliximab
  • Cyclosporine / therapeutic use
  • Daclizumab
  • Drug Therapy, Combination
  • Graft Rejection / epidemiology
  • Graft Rejection / immunology*
  • Humans
  • Immunoglobulin G / therapeutic use
  • Immunosuppressive Agents / therapeutic use*
  • Incidence
  • Liver Function Tests
  • Liver Transplantation / immunology*
  • Liver Transplantation / physiology
  • Mycophenolic Acid / analogs & derivatives*
  • Mycophenolic Acid / therapeutic use
  • Recombinant Fusion Proteins*
  • Retrospective Studies
  • Tacrolimus / therapeutic use

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Recombinant Fusion Proteins
  • Cyclosporine
  • Basiliximab
  • Daclizumab
  • Mycophenolic Acid
  • Tacrolimus