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.