Individualized Immunosuppressive Protocol of Liver Transplant Recipient Should be Made Based on Splenic Function Status

Abstract

Background:Lymphocyte subsets play important roles in rejection in liver transplant recipients, and the effect of splenic function on these roles remains unknown. The aim of this study was to explore the feasibility to adjust immunosuppressive agents based on splenic function status through detecting the lymphocyte subsets in liver transplant recipients.Methods:The lymphocyte subsets of 49 liver transplant recipients were assessed in the 309th Hospital of Chinese People's Liberation Army between June 2014 and August 2015. The patients were divided into splenectomy group (n = 9), normal splenic function group (n = 24), and hypersplenism group (n = 16). The percentages and counts of CD4+ T, CD8+ T, natural killer (NK) cell, B-cell, regulatory B-cell (Breg), and regulatory T-cell (Treg) were detected by flow cytometer. In addition, the immunosuppressive agents, histories of rejection and infection, and postoperative time of the patients were compared among the three groups.Results:There was no significant difference of clinical characteristics among the three groups. The percentage of CD19+CD24+CD38+ Breg was significantly higher in hypersplenism group than normal splenic function group and splenectomy group (3.29 ± 0.97% vs. 2.12 ± 1.08% and 1.90 ± 0.99%, P = 0.001). The same result was found in CD4+CD25+FoxP3+ Treg percentage (0.97 ± 0.39% vs. 0.54 ± 0.31% and 0.56 ± 0.28%, P = 0.001). The counts of CD8+ T-cell, CD4+ T-cell, and NK cell were significantly lower in hypersplenism group than normal splenic function group (254.25 ± 149.08 vs. 476.96 ± 225.52, P = 0.002; 301.69 ± 154.39 vs. 532.50 ± 194.42, P = 0.000; and 88.56 ± 63.15 vs. 188.33 ± 134.51, P = 0.048). Moreover, the counts of CD4+ T-cell and NK cell were significantly lower in hypersplenism group than splenectomy group (301.69 ± 154.39 vs. 491.89 ± 132.31, P = 0.033; and 88.56 ± 63.15 vs. 226.00 ± 168.85, P = 0.032).Conclusion:Splenic function status might affect the immunity of liver transplant recipients, that should be considered when we make immunosuppressive protocols.

Perioperative Single-Donor Platelet Apheresis and Red Blood Cell Transfusion Impact on 90-Day and Overall Survival in Living Donor Liver Transplantation

“…Thus, the recipient-related valuables, for example, age, gender, diagnosis, previous abdominal surgery, body weight, graft-to-recipient weight ratio (GRWR, %), Child-Pugh classification, and model for end-stage liver disease (MELD) score calculated with the most recent blood test results available before LDLT, were all included. [ 1 2 6 24 25 26 27 28 29 ] MELD score = 9.6 × Ln creatinine (mg/dl) + 3.8 × Ln bilirubin (mg/dl) + 11.2 × Ln (INR) + 6.4 × etiology (biliary or alcoholic cirrhosis was 0, otherwise 1). [ 30 ] Donor-related variables such as donor age, gender, and graft weight were also collected.…”

“…However, a remaining challenge for the transplantation community is a relative scarcity of deceased donor graft. [ 1 2 ] Therefore, in addition to deceased donor LT (DDLT), living donor LT (LDLT) has emerged as a solution to the lack of deceased donor organs and has effectively expanded the donor pool. [ 2 ] Although it is a complicated surgical procedure that deals with the right or left lobe and dramatic physiological changes resulting from liver regeneration,[ 3 ] a recent meta-analysis revealed that LDLT was associated with a higher rate of surgical complications but with no significant difference in perioperative mortality compared to DDLT.…”

Compromised immune status of patients with post-liver transplant biliary complications

“…Therefore, IS therapy for LTx patients should be tailored to the immune status of the individual patient. [ 1 ] Biliary complications (BC), including biliary strictures with cholangitis, are the most common complications after LTx. However, the immunological characteristics especially T cell-mediated immunity of these patients are unknown yet.…”