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Pre-Transplantation Immune Cell Distribution and Early Post-Transplant Fungal Infection Are the Main Risk Factors of
N M Abdelhamid1, Y-C Chen2, Y-C Wang3
1General Surgery Department, Al-Azhar Faculty of Medicine, Cairo, Egypt; Liver Transplantation Department, Chang Gung Memorial Hospital, Linko, Taiwan.
Background:
The prognosis of patients after liver transplantation (LTx) with high Model of End-Stage Liver Disease (MELD) score (>30) is predicted, but patients with lower MELD scores (<30) have no conclusive studies of pre- and post-transplant risk factors that influence the long-term outcome.
Methods:
This retrospective study reviewed 268 recipients with MELD score <30, from 2008 to 2013 in our institution, for evaluation of pre-transplant risk factors including patients' clinical background data, pre-transplant lymphocyte subpopulation, and early post-transplant infection complication as predictors for long-term survival after LTx.
Results:
The post-transplant patients' survival estimates were 90.7%, 85.1%, and 83.6% at 1, 3, and 5 years, respectively. In multivariate analysis, age >55years, presence of ascites, cluster of differentiation (CD)3 < 93.2 (count/μL), CD4/CD8 <2.4, fungal infection, and more than one site of fungal colonization significantly influenced survival (P = .0003, P = .002, P = .04, P = .004, P < .0001, and P > .0001, respectively). We also noticed that these five factors accumulatively influence the long-term survival rate; this means that in the presence of any two risk factors, the 5-year survival can still be 88.4%, whereas in the presence of any three risk factors, the survival rate dropped to only 57.1%.
Conclusions:
Older patients in the presence of pre-transplant low immune cell number and ascites in association with post-transplant fungal infection are the independent risk factors in MELD scores <30 LTx groups for long-term survival. Patients in these groups with any of the three factors had inferior long-term survival results.
Insights
Liver transplant recipients with lower MELD scores (<30) face risks from older age, ascites, low immune cells, and fungal infections. Identifying these factors improves long-term survival predictions after liver transplantation.
Area of Science:
- Hepatology
- Transplantation Immunology
- Infectious Diseases
Background:
- Prognosis for liver transplant (LTx) patients with high Model of End-Stage Liver Disease (MELD) scores (>30) is established.
- Limited research exists on pre- and post-transplant risk factors influencing long-term outcomes in patients with lower MELD scores (<30).
Purpose of the Study:
- To evaluate pre-transplant risk factors and early post-transplant infections as predictors of long-term survival in liver transplant recipients with MELD scores <30.
- To identify specific clinical, immunological, and infectious parameters affecting outcomes in this patient cohort.
Main Methods:
- Retrospective review of 268 liver transplant recipients with MELD score <30 (2008-2013).
- Analysis of pre-transplant clinical data, lymphocyte subpopulations (CD3, CD4/CD8 ratio), and post-transplant fungal infections.
- Multivariate analysis to determine independent predictors of long-term survival.
Main Results:
- Overall 1, 3, and 5-year survival rates were 90.7%, 85.1%, and 83.6%, respectively.
- Independent risk factors for reduced survival included age >55, ascites, low CD3 counts (<93.2/μL), low CD4/CD8 ratio (<2.4), and fungal infections (including multiple colonization sites).
- The cumulative effect of risk factors significantly impacted survival; presence of three factors reduced 5-year survival to 57.1%.
Conclusions:
- Older age, pre-transplant low immune cell counts (CD3, CD4/CD8), ascites, and post-transplant fungal infections are key independent risk factors for long-term survival in MELD <30 liver transplant recipients.
- Patients with any three of these risk factors exhibit significantly inferior long-term survival outcomes.
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