Recipient risk factors for acute cellular rejection after orthotopic liver transplant - a single-center,...

Area of Science:

• Hepatology
• Transplant Immunology
• Nephrology

Background:

• The Model for End-Stage Liver Disease (MELD) score implementation changed liver allocation, leading to sicker patients undergoing orthotopic liver transplant (OLT).
• This shift raises questions about potential changes in the risk factors and severity of acute cellular rejection (ACR).

Purpose of the Study:

• To investigate the characteristics of ACR in adult OLT recipients transplanted during the MELD score era.
• To identify specific risk factors associated with ACR development in patients receiving a steroid-sparing immunosuppression regimen.

Main Methods:

• A retrospective analysis of 174 adult OLT patients transplanted between 2008 and 2013 at a single tertiary care center.
• Collection of recipient demographics, preoperative clinical data, and laboratory results.
• Univariate and multivariate regression analyses to determine significant predictors of ACR.

Main Results:

• The median MELD score at transplantation was 29.5.
• The average time to ACR diagnosis was 283.9 days, with most episodes being mild to moderate.
• Serum creatinine levels, primary sclerosing cholangitis as the liver disease etiology, and tacrolimus use were identified as significant predictors of ACR (P < 0.05).

Conclusions:

• The study confirms a shift in the timing and severity of ACR in the MELD score era.
• Recipient characteristics, including serum creatinine and specific disease etiologies, are crucial factors influencing ACR risk.
• These findings suggest that individualized immunosuppression management is necessary to address altered ACR profiles in the current transplant landscape.