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.
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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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