Allograft rejection in pediatric liver transplantation: Comparison between cadaveric and living related donors.

The aim of this study was to determine whether living related liver transplantation has an immunological advantage compared with cadaveric liver transplants in children. The records of 100 pediatric primary liver transplant recipients performed between January 1992 and December 1998 at the University of California, San Francisco Medical Center, were reviewed retrospectively. Ten children who died or required a second graft within the first 14 post-operative days were excluded from this study group. Two children with combined kidney-liver transplants were also excluded. As a result, the study group included 51 children in the cadaveric liver transplantation (CLT) group and 37 children in the living-related liver transplantation (LRLT) group. Until 1995, primary immunosuppression consisted of cyclosporin A, azathioprine and steroids. Since 1995, primary immunosuppression consisted of cyclosporin A, mycophenolate mofetil and steroids. Actuarial graft survival rates at 1, 2 and 5 yrs were 90%, 80.9% and 80.9% in the CLT group vs. 94.6%, 91.6% and 78.5% in the LRLT group, respectively (NS). Rejection was diagnosed in 40 of 51 cadaveric first grafts (78.4%) and 25 of 37 living-related primary grafts (67.6%). Rejection episodes were diagnosed greater than 1 yr post-transplantation in 11 of 51 cadaveric first grafts (21.6%) and none of 37 living-related primary grafts (0%) (p < 0.05). LRLT succeeded in reducing the immunosuppressive therapy compared with CLT at 24 months after transplantation (p < 0.05). The overall incidence of rejection and graft survival rate were comparable in CLT and LRLT; however, rejection episodes in LRLT recipients diagnosed greater than 1 yr post-transplant were significantly fewer than CLT recipients. LRLT have a partial immunological advantage compared with CLT.