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ANGIOTENSIN CONVERTING ENZYME GENE POLYMORPHISMS IN PEDIATRIC LIVER TRANSPLANT RECIPIENTS.
Medhat Askar, MD, PhD, Yehia Awadalla, MD, PhD, George Mazariegos, MD, Alan Zahorchak, BS, Jorge Reyes, MD, Holly Chapman, MD, Angus Thompson, PhD and Adrian Zeevi, PhD. University of Pittsburgh Transplantation Pathology and University of Pittsburgh Surgery.

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Background:
Recent studies have reported the association of angiotensin converting enzyme (ACE) genetic variability with differential risk for development of post-transplant complications in both renal and cardiac allografts.
Objective:
To investigate the frequency of different ACE gene polymorphisms in recipients of pediatric liver transplants.
Methods:
We studied 3 groups of recipients. Group 1 included tolerant recipients (n=13, off immunosupresssion for 1.8-22 years). Group 2 comprised of recipients on progressive weaning (n=35, 0.7-2.7 years). The third group included recipients on maintenance immunosuppression (n=18, 1.3-19 years). Polymerase chain reactions (PCR) were carried out to detect insertion/deletion (I/D) polymorphism of the ACE in the study groups. Patients were assigned to 3 genotypes; I/I, I/D, and D/D.
Results:
Among the tolerant recipients 5 were D/D genotype (38%), 1 was I/I (7%), and 7 were I/D (55%). In group 2, nine recipients were DD (26%), 3 were I/I (9%), and 23 were I/D (65%). In the third group 5 recipients were D/D (28%), 2 were I/I (11%), and 11 were I/D (61%). Due to the inherent problem of small numbers within each group none of the values reached statistical significance. However, there is a tendency for higher frequency of DD homozygous genotype among tolerant patients (38%) compared to recipients on progressive weaning (26%) and maintenance immunosuppression (28%) protocols.
Conclusion:
Results of our study demonstrate a possible association between the DD genotype of ACE gene polymorphism and tolerance following pediatric liver transplantation.