These authors contributed equally to this manuscript.
Decreased Risk of Graft Failure with Maternal Liver Transplantation in Patients with Biliary Atresia
Article first published online: 30 DEC 2011
© 2011 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 12, Issue 2, pages 409–419, February 2012
How to Cite
Nijagal, A., Fleck, S., Hills, N. K., Feng, S., Tang, Q., Kang, S. M., Rosenthal, P. and MacKenzie, T. C. (2012), Decreased Risk of Graft Failure with Maternal Liver Transplantation in Patients with Biliary Atresia. American Journal of Transplantation, 12: 409–419. doi: 10.1111/j.1600-6143.2011.03895.x
- Issue published online: 27 JAN 2012
- Article first published online: 30 DEC 2011
- Received 04 July 2011, revised 22 September 2011 and accepted for publication 17 October 2011
- Biliary atresia;
- living-related liver transplantation;
The presence of maternal cells in offspring may promote tolerance to noninherited maternal antigens (NIMAs). Children with biliary atresia (BA) have increased maternal cells in their livers, which may impact tolerance. We hypothesized that patients with BA would have improved outcomes when receiving a maternal liver. We reviewed all pediatric liver transplants recorded in the SRTR database from 1996 to 2010 and compared BA and non-BA recipients of maternal livers with recipients of paternal livers for the incidences of graft failure and retransplantation. Rejection episodes after parental liver transplantation were examined for patients transplanted at our institution. BA patients receiving a maternal graft had lower rates of graft failure compared to those receiving a paternal graft (3.7% vs. 10.5%, p = 0.02) and, consequently, fewer episodes of retransplantation (2.7% vs. 7.5%, p = 0.04). These differences were not seen among non-BA patients or among BA patients who received female deceased donor grafts. In patients transplanted at our institution, paternal liver transplantation was associated with an increased incidence of refractory rejection compared to maternal liver transplantation only in BA. Our data support the concept that maternal cells in BA recipients promote tolerance to NIMAs and may be important in counseling BA patients who require liver transplantation.