Allograft rejection in pediatric recipients of living related liver transplants

The purpose of this study was to compare the incidence and severity of rejection episodes in a group of children receiving living related orthotopic liver transplants (LRLT) versus children receiving cadaveric liver transplants (CLT). Thirty-eight patients received primary LRLT and 54 patients received CLT during a 3-year period ending June 1993. Baseline immunosuppression consisted of cyclosporin, azathioprine, and corticosteroids. Rejection episodes were confirmed by liver histology and were treated initially with pulse intravenous methylprednisolone, 10 mg/kg/d for 3 days. Steroid-resistant rejection was treated with OKT3 or FK506. The median patient ages were 1.3 years for the CLT and .8 years for the LRLT recipients. Acute cellular rejection developed in 78% of the CLT grafts and 74% of the LRLT grafts (P = ns). However, steroid-resistant rejection was significantly less frequent in the LRLT recipients, 13% versus 43% in the CLT recipients (P < .01). Ductopenic rejection was diagnosed in 20% of CLT and 8% of LRLT grafts (P < .10), and graft loss caused by rejection was 9% in the CLT and 3% in the LRLT group (P = ns). In conclusion, the overall incidence of rejection is the same in LRLT and CLT recipients, but LRLT recipients are less likely than CLT recipients to develop steroid-resistant rejection or ductopenic rejection.