Recipient risk factors for acute cellular rejection after orthotopic liver transplant ‐ a single‐center, retrospective study

Abstract

SUMMARY The use of model for end‐stage liver disease (MELD) score for liver allocation has resulted in transplanting sicker patients. As such, it is unclear whether the risk factors and severity of acute cellular rejection (ACR) have changed. To identify ACR characteristics where average MELD score at transplant is higher than previously published studies. This is a single‐center, retrospective study designed to assess risk factors associated with ACR after adult orthotopic liver transplant (OLT) using a steroid sparing regimen. This study included 174 OLT patients transplanted from 2008 to 2013 at a single tertiary care center. Recipient demographics, preoperative clinical, and laboratory data were recorded for each transplant. Univariate and multivariate regression analyses were performed to identify variables that are significant predictors for ACR. The median MELD at transplantation was 29.5. The average time from transplant to ACR diagnosis was 283.9 days and a majority of ACR episodes were mild to moderate. Serum creatinine, primary sclerosing cholangitis etiology, and tacrolimus use were significant predictors for ACR (P < 0.05). This study confirmed a change in timing and severity of ACR in the MELD era. Recipient characteristics may affect the risk for developing ACR and should be considered when managing immunosuppression.

Evaluating the Incidence and Risk Factors for Acute Cellular Rejection in a Steroid Sparing Liver Transplant Center

“…In a previous study assessing ACR and risk factors after LT at the same transplant center between 2008 to 2013 the reported incidence of ACR was 26.4% with a median time to first rejection of 283 days. 5 Similar findings were noted in this study with longer length of follow up time from transplant at the same center; therefore, no era effect was identified between the 2 cohorts.…”

“…Acute cellular rejection (ACR) is a concerning complication after liver transplantation (LT) that is associated with a high morbidity rate. 1 With the introduction of more potent immunosuppression (IMS) regimens, the incidence of ACR is estimated to be 12% to 26% after LT. [2][3][4][5] According to the 2019 Organ Procurement and Transplantation Network (OPTN)/Scientific Registry of Transplant Recipients (SRTR) Annual Data Report, the predominant IMS regimen used after adult LT is a combination of tacrolimus, mycophenolate and steroids (71.0%). 2 Historically, the use of corticosteroids has been the mainstay for IMS following LT.…”

“…In a previous single-center retrospective study assessing LT undergoing steroid withdrawal, serum creatinine (SCr) and PSC were independent risk factors for ACR; whereas, tacrolimus use was a protective factor. 5 However, changes to both IMS protocols and organ transplant allocation policies have changed since these findings. Furthermore, this evaluation included simultaneous liver-kidney (SLK) transplant recipients, which may have an impact on the findings including the relationship between SCr and increased ACR risk.…”

Safety of Tacrolimus Monotherapy within 12 Months after Liver Transplantation in the Era of Reduced Tacrolimus and Mycophenolate Mofetil: National Registry Study

“…In addition to studies published before 2000 [ 20 , 21 , 22 ], a large study performed in the modern era with improved immunosuppressive regimens also showed that rejection significantly increased graft failure or death in LT recipients [ 14 ]. Although there has been considerable interest in minimizing or even completely withdrawing immunosuppressants [ 23 , 24 ], the 10–30% incidence of rejection limits the application of these strategies in clinical settings [ 25 , 26 ]. A recent randomized trial reported that immunosuppressant minimization was achievable only in selected patients and did not result in reductions in infection, malignancy, or renal impairment [ 27 ].…”