P- 58 CLINICAL OUTCOMES OF PATIENTS WITH GRAFT REJECTION FOLLOWING TRANSPLANTATION FOR AUTOIMMUNE LIVER DISEASE AT A LIVER TRANSPLANT CENTER IN COLOMBIA

Introduction and Objectives

Liver transplantation is the best treatment option for patients with cirrhosis and advanced autoimmune liver disease. Approximately 15-25% of transplanted patients experience acute graft rejection with standard immunosuppression regimens, and, less frequently, chronic rejection. There is limited evidence in Colombia regarding the incidence of these events and their impact on graft and patient survival. This study aims to characterize the rejection rates in patients transplanted for autoimmune liver disease at a Colombian liver transplant center.

Materials and Methods

Descriptive retrospective longitudinal study of a cohort of patients with autoimmune liver disease who underwent liver transplantation from November 2005 to December 2022.

Results

A total of 163 patients were transplanted for autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and overlap syndromes. The rejection rate in this population within the first year was 17.8% (n=29), between the first and fifth year was 22% (n=36), and between the fifth and tenth year was 6.3% (n=10). Acute rejections accounted for 90.7% of the cases. Approximately 80% of the patients were managed with calcineurin inhibitors plus mycophenolate, with or without corticosteroids, and 92.7% had immunosuppression levels within target range. The overall mortality rate was 14.6% (n=24): 7.36%(n=12) in AIH, 3.06% (n=5) in PBC, 3.6% (n=6) in overlap syndromes, and 0.6% (n=1) in PSC.

Conclusions

In this population, the acute rejection rates at one year, five years, and ten years after liver transplant were similar to those reported in the literature. However, patients transplanted for autoimmune liver disease have a higher rejection rate than other cirrhosis etiologies. These findings should prompt the evaluation of adjustments in immunosuppression protocols and determine other factors associated with rejection, such as the relationship between histocompatibility and rejection risk.