Objectives: It has been reported that the living donor liver transplantation (LDLT) in which the patients received a maternal graft could be more successful compared with paternal one because of the tolerance for maternal antigens which could be resulted from the exposures of the non-inherited maternal antigens (NIMA) during gestation. We reviewed our cases, who had undergone LTLD, to investigate the relationship between the acute cellular rejection (ACR) and the donor type.

Methods: The patients, who had LDLT between January 2010 and November 2015 in our institute, were included for this study. Age, sex, original disease, donor type, donor age, ACR episodes, were gathered from their charts. ACR was defined by biopsy proven as more than 2 Rejection Activity Index (RAI). Patients were divided into maternal and paternal graft groups. ACR episodes were analyzed with Kaplan-Meier

Results: 46 patients (22 males and 24 females) were enrolled. The median age of these patients was 2.8 year-old (ranged from 0.61 to 20.7). The original disease were biliary atresia (n=28), hepatoblastoma (n=6), fulminant hepatic failure (n=4), Wilson disease (n=2), OTC deficiency (n=2), autoimmune hepatitis (n=1), Alagille syndrome (n=1), primary sclerosing cholangitis (n=1) and Citrine deficiency (n=1). Donor median age was 39.5 year-old (ranged from 21 to 52). Donor type were maternal (n=25) and paternal (n=21). The ACR was observed in 22 patients. 12 (48%) of 25 patients in the maternal group had at least one episode of rejection after transplantation compared with 10 (48%) of 21 patients in the paternal group.

Among the patients with ACR, the first rejection of maternal group significantly earlier than those of paternal group (p = 0.0079; median first post-operative day were 15 (95%CI 7-29) in the patients with maternal donor and 191 (95%CI 7-359) in the patients with paternal donor).

Conclusion: Our results showed that, although there was no significant difference in the proportion of rejection between maternal and paternal group, but maternal graft had an effect to cause earlier ACR in pediatric LTLD. Further investigation should be needed to prove the tolerance for NIMA in transplantation settings.

CITATION INFORMATION: Noguchi Y, Ueno T, Bessho K, Takama Y, Yamanaka H, Tanaka N, Tazuke Y, Okuyama H. The Effect of Maternal Graft in Early Acute Cellular Rejection After Pediatric Living Donor Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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