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Liver allograft radiotherapy to treat rejection in children: efficacy in orthotopic liver transplantation and long-term safety.

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Stéphenne, Xavier [UCL] Najimi, Mustapha [UCL] Janssen, Magdalena [UCL] Reding, Raymond [UCL] de Ville de Goyet, Jean [UCL] Sokal, Etienne [UCL]

BACKGROUND: We studied, retrospectively, the efficacy to control rejection and long-term safety of liver allograft radiotherapy (RT) performed in 14 children. Long-term safety data were collected with the prospect of possible use of RT in liver cell transplantation (LCT). METHODS: Immune suppression included cyclosporine, azathioprine and prednisone. In case of intractable rejection, low-dose allograft RT was administered daily for 3 days, and short-term efficacy was evaluated by liver enzyme assays and histology. The long-term outcome was compared with that of 122 patients undergone transplantation and who had similar treatment, but no RT. RESULTS: Survival at 15 years was 71.4% vs 69.7% in the comparison group. In the RT group, rejection control was complete in six of 14 children and partial in two, all being alive and well 14-18 years later. Ten of 14 children had follow-up biopsy. Six children had normal histology and four had mild unspecific fibrosis. The long-term follow-up biopsy in the comparison group showed fibrosis in 42 of 85 children. The incidence of complications was similar in both groups. CONCLUSIONS: This series shows that, such a RT regimen appeared to be efficient and safe as a rescue treatment for acute rejection. Provided that further investigations in animal models show a certain benefit of low-dose irradiation around LCT, such a regimen could be proposed in human liver cell transplant programmes.

  1. Reding Raymond, Feyaerts Axel, Vraux Hubert, Latinne Dominique, De La Parra Bernardo, Cornet Anne, Cormont Fran??oise, Jamart Jacques, Sokal Etienne, de Goyet Jean de Ville, Lerut Jan, Bazin Herv??, Otte Jean-Bernard, PROPHYLACTIC IMMUNOSUPPRESSION WITH ANTI-INTERLEUKIN-2 RECEPTOR MONOCLONAL ANTIBODY LO-TACT-1 VERSUS OKT3 IN LIVER ALLOGRAFTING : A Two-Year Follow-up Study, 10.1097/00007890-199605150-00022
  2. Reding R, Transplant Proc, 23, 3002 (1991)
  3. Reding R, Transplantation, 55, 534 (1993)
  4. Fox Ira J., Chowdhury Jayanta Roy, Kaufman Stuart S., Goertzen Timothy C., Chowdhury Namita Roy, Warkentin Phyllis I., Dorko Kenneth, Sauter Bernhard V., Strom Stephen C., Treatment of the Crigler–Najjar Syndrome Type I with Hepatocyte Transplantation, 10.1056/nejm199805143382004
  5. Sokal Etienne M., Smets Fran??oise, Bourgois Annick, Van Maldergem Lionel, Buts Jean-Paul, Reding Raymond, Bernard Otte Jean, Evrard Veerle, Latinne Dominique, Vincent Marie Fran??oise, Moser Anne, Soriano Humberto E., Hepatocyte transplantation in a 4-year-old girl with peroxisomal biogenesis disease: technique, safety, and metabolic follow-up1 : , 10.1097/01.tp.0000077420.81365.53
  6. DEPARTMENT OF ERROR, 10.1016/s0140-6736(02)08461-1
  7. Horslen S. P., McCowan T. C., Goertzen T. C., Warkentin P. I., Cai H. B., Strom S. C., Fox I. J., Isolated Hepatocyte Transplantation in an Infant With a Severe Urea Cycle Disorder, 10.1542/peds.111.6.1262
  8. Guha C, Cancer Res, 59, 5871 (1999)
  9. Cames B, J Pediatr, 120, 33 (1992)
  10. Reding R, Transplantation X, 57, 93 (1994)
  11. Batts K P, Am J Surg Pathol, 19, 1409 (1995)
  12. Smets Fran??oise, Vajro Pietro, Cornu Guy, Reding Raymond, Otte Jean Bernard, Sokal Em, INDICATIONS AND RESULTS OF CHEMOTHERAPY IN CHILDREN WITH POSTTRANSPLANT LYMPHOPROLIFERATIVE DISEASE AFTER LIVER TRANSPLANTATION1 : , 10.1097/00007890-200003150-00053
  13. Ho M, Transplantation, 45, 719 (1988)
  14. Randhawa P S, N Engl J Med, 327, 1710 (1992)
  15. Pastore M, Arch Dis Child, 72, 403 (1995)
  16. Smets Françoise, Bodeus Monique, Goubau Patrick, Reding Raymond, Otte Jean-Bernard, Buts Jean-Paul, Sokal Etienne Marc, Characteristics of Epstein-Barr virus primary infection in pediatric liver transplant recipients, 10.1016/s0168-8278(00)80195-6
  17. Smets Fran??oise, Latinne Dominique, Bazin Herv??, Reding Raymond, Otte Jean-Bernard, Buts Jean-Paul, Sokal Etienne M., Ratio between Epstein-Barr viral load and anti-Epstein-Barr virus specific T-cell response as a predictive marker of posttransplant lymphoproliferative disease1 : , 10.1097/00007890-200205270-00014
  18. Sokal E M, Transplantation, 56, 1394 (1993)
  19. Reding Raymond, Gras Jérémie, Sokal Etienne, Otte Jean-Bernard, Davies Hugh FS, Steroid-free liver transplantation in children, 10.1016/s0140-6736(03)15104-5
  20. Koffman B.H., Kennedy A.S., Heyman M., Colonna J., Howell C., Use of radiation therapy in posttransplant lymphoproliferative disorder (PTLD) after liver transplantation, 10.1002/(sici)1097-0215(20000420)90:2<104::aid-ijc6>3.0.co;2-0
  21. Inskip P D, Radiat Res, 135, 108 (1993)
  22. Noyes William R., Rodriguez Rey, Knechtle Stuart J., Pirsch John D., Sollinger Hans W., D'Alessandro Anthony M., Chappell Rick, Belzer Folkert O., Kinsella Timothy J., Radiation therapy for renal transplant rejection refractory to pulse steroids and OKT3, 10.1016/0360-3016(95)02159-0
  23. Torrisi John R., Dritschilo Anatoly, William Harter K., Helfrich Baird, Berg Christine D., Whitfield Glen, Stablein Donald, Alijani Mohammed, A randomized study of the efficacy of adjuvant local graft irradiation following renal transplantation, 10.1016/0360-3016(90)90437-o
  24. Jagetia Rakesh, Small William, Stuart Frank P., Shetty Ramananda, Stuart Joan, Kanwar Y.S., Mittal Bharat B., Local graft irradiation after failure of modern immunosuppression in acute cellular and vascular graft rejection, 10.1016/s0360-3016(96)00340-9
  25. Halperin Edward C., Delmonico Francis L., Nelson Paul W., Shipley William U., Cosimi A.Benedict, The use of local allograft irradiation following renal transplantation, 10.1016/0360-3016(84)90168-8
  26. Chen Luci M, Godinez Juan, Thisted Ronald A, Woodle E.Steve, Thistlewaite J.Richard, Powers Claire, Haraf Daniel, New scoring system identifies kidney outcome with radiation therapy in acute renal allograft rejection, 10.1016/s0360-3016(99)00474-5
  27. Galvao M M, Rev Paul Med, 116, 1710 (1998)
  28. Zavos G, Bokos J, Papaconstantinou J, Boletis J, Gazouli M, Pappas P, Kostakis A, Study of “de novo” malignancies among greek renal transplant recipients, 10.1016/s0041-1345(03)00518-9
  29. Guha C, Normal hepatocytes correct serum bilirubin after repopulation of Gunn rat liver subjected to irradiation/partial resection, 10.1053/jhep.2002.34516
  30. Takahashi M, Deb N J, Kawashita Y, Lee S W, Furgueil J, Okuyama T, Roy-Chowdhury N, Vikram B, Roy-Chowdhury J, Guha C, A novel strategy for in vivo expansion of transplanted hepatocytes using preparative hepatic irradiation and FasL-induced hepatocellular apoptosis, 10.1038/sj.gt.3301909
Bibliographic reference Stéphenne, Xavier ; Najimi, Mustapha ; Janssen, Magdalena ; Reding, Raymond ; de Ville de Goyet, Jean ; et. al. Liver allograft radiotherapy to treat rejection in children: efficacy in orthotopic liver transplantation and long-term safety.. In: Liver International, Vol. 25, no. 6, p. 1108-1113 (2005)
Permanent URL http://hdl.handle.net/2078.1/10422