Combined Bio-histological assessment as a tool to refine diagnosis and avoid overtreatment of early T cell-mediated rejection after liver transplantationOA
Background:Early post-transplant T cell-mediated rejection(TCMR)is commonly defined by histology alone.However,isolated early histological rejection after liver transplantation(LT)often resolves spontaneously and may lead to overtreatment,excessive steroid exposure,and avoidable immunosuppressionrelated morbidity.Clinically meaningful criteria to distinguish patients who truly require treatment remain poorly defined.Methods:This single-center study included 421 consecutive adult LT recipients undergoing routine day-7 protocol biopsy between 2000 and 2016,managed with a standardized immunosuppression-minimization strategy and complete long-term follow-up.The Seven-Up score integrated day-7 Banff histology(0–9)with a biological score(Bio-score,0–4)derived from dynamic changes in total bilirubin,platelet count,and eosinophil count between postoperative day 5 and day 7.Very early(<15 d)clinically relevant rejection was defined as Banff 6–9 combined with Bio-score>2.Incidence of histological and clinically relevant TCMR,graft survival,patient survival,and diagnostic performance of the Bio-score were analyzed.Results:At day 7,157 recipients(37.3%)exhibited Banff 6–9 rejection,whereas 264(62.7%)had Banff 0–5.A biopsy-only strategy would have resulted in steroid treatment in all 157 patients.Application of the Seven-Up score identified only 19 patients(4.5%)requiring very early antirejection therapy,sparing one in three recipients(138 patients,32.8%).Long-term graft and patient survival were comparable between the treated and untreated groups.The Bio-score demonstrated good diagnostic accuracy for very early clinically relevant TCMR[area under the curve(AUC)=0.78;95%confidence interval(CI):0.68–0.89;P<0.001),supporting its role as a non-invasive surrogate of early immune activity.
Jan P Lerut;Quirino Lai;Jose-Luis Beristain-Hernandez;Liliana Ducatti;Rafael Soares Pinheiro;Juan Manual Rico Juri;Milton Eduardo Inostroza Núnez;Bridget K Gunson;Kevin Ackenine;Kente Baami-Mariza;Marwan Nadiri;Giorgia Romano;Eliano Bonaccorsi Riani;Olga Ciccarelli;Laurent Coubeau;Francine Roggen;Chantal De Reyck;Samuele Iesari
Institute for Experimental and Clinical Research(IREC),Universitécatholique Louvain(UCL),Avenue Hippocrates 56,Brussels 1200,BelgiumGeneral Surgery and Organ Transplantation Unit,Sapienza University of Rome,AOU Policlinico Umberto I,Rome,ItalyDepartment of Hepatobiliary and Pancreatic Surgery,Hospital de Especialidades Dr.Antonio Fraga Mouret,Centro Medico Nacional La Raza,IMSS.Mexico City,MexicoDepartamento de Gastroenterologia,Divisao de Transplantes de Figado e Orgaos do Aparelho Digestivo,Hospital das Clinicas(HCFMUSP),Faculdade de Medicina,Universidade de Sao Paulo,SP,BrazilDepartamento de Gastroenterologia,Divisao de Transplantes de Figado e Orgaos do Aparelho Digestivo,Hospital das Clinicas(HCFMUSP),Faculdade de Medicina,Universidade de Sao Paulo,SP,BrazilUnidad de Trasplante y Cirurgía HBP,Clinica Imbanaco,Quirón Salud Group,Cali,ColombiaDepartamento de Cirurgia Universidad Concepcion,Concepcion,ChileThe Liver Unit,University Hospital Birmingham,Birmingham,UKInstitute for Experimental and Clinical Research(IREC),Universitécatholique Louvain(UCL),Avenue Hippocrates 56,Brussels 1200,BelgiumInstitute for Experimental and Clinical Research(IREC),Universitécatholique Louvain(UCL),Avenue Hippocrates 56,Brussels 1200,BelgiumInstitute for Experimental and Clinical Research(IREC),Universitécatholique Louvain(UCL),Avenue Hippocrates 56,Brussels 1200,BelgiumInstitute for Experimental and Clinical Research(IREC),Universitécatholique Louvain(UCL),Avenue Hippocrates 56,Brussels 1200,BelgiumDepartment of Abdominal and Transplantation Surgery,Starzl Unit of Abdominal Transplantation,Universitécatholique de Louvain(UCL),Cliniques Universitaires Saint-Luc,Brussels,BelgiumDepartment of Abdominal and Transplantation Surgery,Starzl Unit of Abdominal Transplantation,Universitécatholique de Louvain(UCL),Cliniques Universitaires Saint-Luc,Brussels,BelgiumDepartment of Abdominal and Transplantation Surgery,Starzl Unit of Abdominal Transplantation,Universitécatholique de Louvain(UCL),Cliniques Universitaires Saint-Luc,Brussels,BelgiumDepartment of Abdominal and Transplantation Surgery,Starzl Unit of Abdominal Transplantation,Universitécatholique de Louvain(UCL),Cliniques Universitaires Saint-Luc,Brussels,BelgiumDepartment of Abdominal and Transplantation Surgery,Starzl Unit of Abdominal Transplantation,Universitécatholique de Louvain(UCL),Cliniques Universitaires Saint-Luc,Brussels,BelgiumKidney Transplantation,Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico,Milan,Italy
医药卫生
Liver transplantationAcute cellular rejectionClinical rejectionHistologic rejectionBanff scoreImmunosuppression minimizationT cell mediated rejection
《Hepatobiliary & Pancreatic Diseases International》 2026 (3)
P.280-292,13
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