76 Factors Associated with Development of Food Allergy in Liver-Transplanted Children

BACKGROUND: The development of food allergy (FA) after transplantation has been described mainly about liver transplantation in children (Pediatr Allergy Immunol. 2009; 20: 741–747). It has been becoming important issue in this population. Although tacrolimus immunosuppressive therapy has been considered a significant risk factor (J Allergy Clin Immunol. 2011; 127: 1296–1298), other risk factors are not identified yet. This study was undertaken to evaluate the risk factors other than tacrolimus immunosuppressive therapy. METHODS: This study was a retrospective analysis of pediatric liver transplant recipients in our hospital. We reviewed the medical records of all patients who underwent liver transplantation during study period. Data collected including preceding-hepatic diseases, the number of previous surgeries, age at liver transplantation and etc. RESULTS: Between November 2005 and May 2010, 106 children received liver transplantation. The most common indication for liver transplantation was biliary atresia (BA; 47 patiens, 44.3%). The other conditions were: congenital metabolic diseases in 27 patients, fulminant hepatic failure in 19, liver cirrhosis in 6, congenital absence of portal vein in 3, congenital hepatic fibrosis in 2 and hepatic tumor in 2 patients. After transplantation, all the patients received immunosuppressive therapy based on tacrolimus regimen. Fifteen patients (10 female and 5 male) developed new-onset FA (14.2%). The average age at transplantation was 10 months and FA has been developed within 2 years (median 11 months, IQR, 4.5–19.0). Eleven patients with BA (23.4%) and 4 patients with the other conditions (6.8%) developed new-onset FA (P = 0.023). Among the patients who developed FA, the number of previous surgeries was significantly higher in patients with BA (P = 0.008). CONCLUSIONS: New-onset food allergy after liver transplantation is now becoming a significant problem. We observed a trend toward an excess of FA in patients with BA compared to patients with other indications for liver transplantation. Patients with BA received surgical operations in several times before liver transplantation. Frequent operations might add some stimulation to generate new-onset FA and should be considered as a susceptible subgroup that requires specific attention.