Adherence of Immunosuppression Therapy and Donor-specific anti-HLA antibodies in the Pediatric Liver Transplant Recipients. (July 2018)

• Record Type: Journal Article
• Authors: Yoshizawa, Atsushi; Kaneshiro, Masakatsu; Uebayashi, Elena; Suzuki, Kumiko; Ogawa, Eri; Okamoto, Shinya; Okajima, Hideaki; Kaido, Toshimi; Haga, Hironori; Uemoto, Shinji
• Is Part Of: Transplantation. Volume 102(2018)Supplement 7S-1
• Publication Date: 2018-07
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/01.tp.0000543965.36741.75
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Introduction: Medical adherence after liver transplantation is essential to keep good graft function. Inappropriate immunosuppression (IS) stopping in long-term after operation causes late-onset acute rejection and chronic rejection. It was reported that immunosuppression nonadherence causes antibody-mediated rejection. We previously reported that about 40% of pediatric liver transplant recipients had donor-specific anti-HLA antibodies (DSA) more than 3 years after the operation, and that DSA were significantly associated with progressive fibrosis in the graft liver. In this study, we analyzed the association between adherence and occurrence of DSA. Materials and Methods: Study subjects were 152 pediatric liver transplant recipients who underwent liver transplant under 20 more than three years ago. Transplant coordinators performed an in-person interview and scored medical adherence by VAS; taking drugs without skip, successive skip, timing delay, and dose reduction. DSA were examined by solid-phase assay using a Luminex analyzer. underwent liver biopsy during this period. Pathological findings were diagnosed by the specialized pathologists, and fibrosis was scored by METAVIR system. Result: The interview revealed that the frequency of occasional skip of IS, repeated skip (more often than once a week), successive skip (for more than two days), timing delay more than two hours, dose reduction by self-decision was 51%, 16%, 12%, 56%, 1.3%, respectively. The frequency of DSA was 43%, and DSA were mainly against HLA Class II. The progressive fibrosis, bridging fibrosis, was observed in 31% of the recipients. The occurrence of DSA was significantly associated with occasional skip, repeated skip, and successive skip in a univariate study. (p=0.035, 0.0093, and 0.007, respectively.) DSA and progressive fibrosis was not significantly correlated in this study. (p= 0.23) Fibrosis was not significantly correlated with adherence, either. Fibrosis and DSA was significantly correlated with the period after the operation. And, medical nonadherence was significantly associated with the period after operation. Discussion: The long period after the operation was significantly correlated with medical nonadherence and DSA occurrence. The appropriate IS therapy should be continued to prevent occurrence DSA even in the long-term period after operation. Medical adherence was important to keep adequate IS therapy.