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An objective definition for clinical suspicion of T-cell mediated rejection after liver transplantation

Rodríguez-Perálvarez, M; De Luca, L; Crespo, G; Rubin, Á; Marín, S; Benlloch, S; Colmenero, J; ... De la Mata, M; + view all (2017) An objective definition for clinical suspicion of T-cell mediated rejection after liver transplantation. Clinical Transplantation , 31 (7) 10.1111/ctr.13005. Green open access

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Abstract

A uniform definition of clinical suspicion of T-cell mediated rejection (TCMR) in liver transplantation (LT) is needed to homogenize clinical decisions, especially within randomized trials. The present multicentre study included a total of 470 primary LT recipients. The derivation cohort consisted of 142 patients who had clinically-driven liver biopsies at any time after LT. The external validation cohort included 328 patients who underwent protocol biopsies at day 7-10 after LT. The rates of moderate-severe histological TCMR were 33.8% in the derivation cohort and 43.6% in the validation cohort. Independent predictors (ie. risk factors) of moderate-severe TCMR in the derivation cohort were: serum bilirubin >4mg/dL (OR=5.83; p<0.001), rising bilirubin within the 4 days prior to liver biopsy (OR=4.57; p=0.003), and blood eosinophils count >0.1*109/L (OR=3.81; p=0.004). In the validation cohort, the number of risk factors was an independent predictor of moderate-severe TCMR (OR=1.74; p=0.001), after controlling for hepatitis C status. The number of risk factors paralleled the rates of moderate-severe TCMR in the derivation and validation cohorts (p<0.001 in both comparisons). In conclusion, increased serum bilirubin, rising bilirubin and eosinophilia are validated risk factors for moderate-severe histological TCMR, and could be used as objective criteria to select candidates for liver biopsy.

Type: Article
Title: An objective definition for clinical suspicion of T-cell mediated rejection after liver transplantation
Location: Denmark
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/ctr.13005
Publisher version: http://doi.org/10.1111/ctr.13005
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Immunosuppression, T-cell mediated rejection, liver biopsy, liver transplantation
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: https://discovery.ucl.ac.uk/id/eprint/1556459
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