The effect of maternal grafts in early acute cellular rejection after pediatric living-donor liver transplantation

PurposeLiving-donor liver transplantations (LDLTs) with maternal grafts can be more successful than those with paternal grafts because of their tolerance to non-inherited maternal antigens. We reviewed LDLT patients to investigate the relationship between acute rejection and donor sex.MethodsLDLT patients between January 2010 and November 2015 were enrolled. ACR was defined by a rejection activity index of >3.ResultsForty-six patients (22 males and 24 females), of whom 28 had biliary atresia, were enrolled. The median age of the patients was 2.8years and the donor types were maternal (n=25) and paternal (n=21). Acute cellular rejection (ACR) was observed in 22 patients. Twelve (48%) of the 25 patients in the maternal group had at least one episode of rejection compared with 10 (48%) of the 21 in the paternal group. Among the patients with ACR, the first rejection in the maternal group occurred significantly earlier than that in the paternal group (p<0.01). In the multivariable analysis, the only variable significantly related to the first rejection day after LDLT was donor sex (male) (p<0.005).ConclusionOur results showed that maternal grafts had an effect on causing earlier ACR in LDLT.