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Incidence and severity of acute allograft rejection in liver transplant recipients treated with alfa interferon

Jain, A and Demetris, AJ and Manez, R and Tsamanadas, AC and Van Thiel, D and Rakela, J and Starzl, TE and Fung, JJ (1998) Incidence and severity of acute allograft rejection in liver transplant recipients treated with alfa interferon. Liver Transplantation and Surgery, 4 (3). 197 - 203. ISSN 1074-3022

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Abstract

Interferon alfa-2b (IFN-α) therapy has been shown to be effective in the treatment of viral hepatitis B (HBV) or viral hepatitis C (HCV) in patients who did not undergo transplantation. However, in allograft recipients, treatment with IFN-α often leads to allograft rejection. The aim of the present study was to determine if IFN-α therapy increases the incidence or severity of acute rejection in human liver allograft recipients. One hundred five orthotopic liver transplant (OLT) recipients with HBV (n = 32), HCV (n = 58), or Non A Non B Non C (n = 15) viral infections were treated with a 6-month course of IFN-α, 5 million U subcutaneously three times a week, which began 2 to 97 months after transplantation. The mean hepatitis activity index (HAI) at the beginning of the therapy was 10.1 ± 3.0. The baseline immunosuppression was achieved by tacrolimus in 77 patients and by cyclosporine A (CyA) in 28 patients. Contemporaneous controls consisted of 132 OLT patients (100 who received tacrolimus and 32 who received CyA) who did not receive IFN-α. A retrospective analysis was performed on this group of patients. The incidence of rejection and the baseline immunosuppression were compared. All biopsies were reviewed without knowledge of clinical data and scored for HAI and for rejection activity index (RAI). The biochemical response to IFN-α was also examined. The mean baseline maintenance dose of prednisone was greater by 2 mg daily in patients who received IFN-α with tacrolimus compared with control patients who did not receive IFN-α with tacrolimus (IFN-α 5.3 ± 5.2 mg daily v controls 3.3 ± 4.9 mg daily; P ≤ .05). Similarly, the mean maintenance dose of prednisone was greater by 2.5 mg daily in patients who received IFN-α compared with controls who received CyA-based immunosuppression (IFN-α 9.8 ± 3.1 mg daily v controls 7.3 ± 3.3 mg daily; P = .01). Acute rejection episodes were detected in 10.5% (n = 11) of IFN-α-treated patients compared with 8.8% of controls for the similar time period from OLT and period of exposure to risk of rejection. Mean RAI was 2.0 ± 2.4 for the IFN-α- treated group and 2.1 ± 1.7 for controls. Rejection episodes with IFN-α treatment were mild and responded to steroid therapy. In OLT recipients, the risk of acute rejection was not increased by the introduction of IFN-α. However, in this study, patients were exposed to greater levels of immunosuppression.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Jain, A
Demetris, AJ
Manez, R
Tsamanadas, AC
Van Thiel, D
Rakela, J
Starzl, TEtes11@pitt.eduTES11
Fung, JJ
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 1998
Date Type: Publication
Journal or Publication Title: Liver Transplantation and Surgery
Volume: 4
Number: 3
Page Range: 197 - 203
DOI or Unique Handle: 10.1002/lt.500040315
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 1074-3022
Other ID: uls-drl:31735062127588, Starzl CV No. 2037
Date Deposited: 08 Apr 2010 17:34
Last Modified: 27 Jan 2019 02:55
URI: http://d-scholarship.pitt.edu/id/eprint/5423

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