SAKURAI Takaki Kyoto University, Faculty of Medicine Assistant Professor, 医学研究科, 助手 (10268625)
TOYOKUNI Shinya Kyoto University, Faculty of Medicine Associate Professor, 医学研究科, 助教授 (90252460)
INOMATA Yukihiro Kyoto University, Faculty of Medicine Associate Professor, 医学研究科, 助教授 (50193628)
|Budget Amount *help
¥3,200,000 (Direct Cost : ¥3,200,000)
Fiscal Year 1999 : ¥800,000 (Direct Cost : ¥800,000)
Fiscal Year 1998 : ¥2,400,000 (Direct Cost : ¥2,400,000)
During the 8 years and 7 months period between June 1990 and December 1998, 412 patients with end-stage liver diseases underwent 423 living related liver transplantation under tacrolimus immunosuppression. Among these, there were 53 ABO incompatible transplants in 51 patients. This report describes the histopathological features of liver dysfunction seen in these ABO-incompatible transplants.
No hyperacute rejection was found. Hepatic artery thrombosis was seen in 7% of transplants, acute/chronic cholangitis in 38%, acute cellular rejection in 59%, chronic rejection in 2%, preservation and reperfusion injury in 2%, acute hepatitis in 25%, chronic hepatitis in 8% and posttransplant lymphoproliferative disorder in 6%. Hepatic artery thrombosis, acute/chronic cholangitis and acute cellular rejection were more frequently seen in ABO incompatible than in ABO identical and compatible transplants. Hepatic artery thrombosis and acute/chronic cholangitis were more frequently seen in transplants
with higher (> x128) pre-and/or post-operative isoagglutinin titers. However, acute cellular rejection was not related to the isoagglutinin titers. Patient death or graft loss occurred in 22 transplants (41.5%). This was more frequent than in ABO identical and compatible transplants (18.6%). Most important causes of transplant failure in these cases were hepatic artery thrombosis and acute/chronic cholangitis. Histopathological analysis of explants that failed due to hepatic artery thrombosis and chronic cholangitis showed that hepatic artery thrombosis is the primary lesion which was followed by large bile duct infarction and acute/chronic cholangitis in the peripheral bile ducts.
From these data, it is suggested that, in ABO incompatible transplants, hepatic artery thrombosis which is a result of reaction between circulating antibodies and ABO blood group antigens expressed on endothelial cells of large hepatic arteries, and acute/chronic cholangitis which is a result of ischemia due to hepatic thrombosis, are responsible for the transplant failure. It is also suggested that there are no relationship between high incidence of acute cellular rejection and isoagglutinins in ABO-incompatible transplants. Less