Low-dose aspirin confers protection against acute cellular allograft rejection after primary liver transplantation

Christian E. Oberkofler, Dimitri A. Raptis, Philip C. Müller, Richard X. Sousa da Silva, Kuno Lehmann, Takahiro Ito, Timothy Owen, Joerg Matthias Pollok, Alessandro Parente, Andrea Schlegel, Peregrina Peralta, Erin Winter, Markus Selzner, Margot Fodor, Manuel Maglione, Manuel Jaklitsch, Hugo P. Marques, Mariana Chavez-Villa, Alan Contreras, Philipp KronPeter Lodge, Scott Alford, Abbas Rana, Paolo Magistri, Fabrizio Di Benedetto, Bethany Johnson, Varvara Kirchner, Francis Bauldrick, Karim J. Halazun, Omid Ghamarnedjad, Arianeb Mehrabi, Samanta Teixeira Basto, Eduardo S.M. Fernandes, Jose Paladini, Martin de Santibañes, Sander Florman, Parissa Tabrizian, Philipp Dutkowski, Pierre Alain Clavien, Ronald W. Busuttil, Fady M. Kaldas, Henrik Petrowsky

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


This study investigated the effect of low-dose aspirin in primary adult liver transplantation (LT) on acute cellular rejection (ACR) as well as arterial patency rates. The use of low-dose aspirin after LT is practiced by many transplant centers to minimize the risk of hepatic artery thrombosis (HAT), although solid recommendations do not exist. However, aspirin also possesses potent anti-inflammatory properties and might mitigate inflammatory processes after LT, such as rejection. Therefore, we hypothesized that the use of aspirin after LT has a protective effect against ACR. This is an international, multicenter cohort study of primary adult deceased donor LT. The study included 17 high-volume LT centers and covered the 3-year period from 2013 to 2015 to allow a minimum 5-year follow-up. In this cohort of 2365 patients, prophylactic antiplatelet therapy with low-dose aspirin was administered in 1436 recipients (61%). The 1-year rejection-free survival rate was 89% in the aspirin group versus 82% in the no-aspirin group (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.63–0.94; p = 0.01). The 1-year primary arterial patency rates were 99% in the aspirin group and 96% in the no-aspirin group with an HR of 0.23 (95% CI, 0.13–0.40; p < 0.001). Low-dose aspirin was associated with a lower risk of ACR and HAT after LT, especially in the first vulnerable year after transplantation. Therefore, low-dose aspirin use after primary LT should be evaluated to protect the liver graft from ACR and to maintain arterial patency.

Original languageEnglish (US)
Pages (from-to)1888-1898
Number of pages11
JournalLiver Transplantation
Issue number12
StatePublished - Dec 2022

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation


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