Allograft tolerance after adult living donor liver transplantation: a case-control study.

IF 1.6 3区 医学 Q2 SURGERY
Mohamed S Habl, Moataz Maher Emara, Reham A Zayed, Ahmed M Sultan, Ahmed Elsabagh, Ahmed Marwan Elsaid, Ehab E Abdel-Khalek, Mohamed M El-Saadany, Mohamed Abdel Wahab, Ahmed Shehta
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Abstract

Background: To investigate the incidence and potential predictors of immune tolerance among adult living donor liver transplant (LDLT) recipients.

Methods: This case-control study included adult recipients who underwent LDLT between May 2004 and January 2018, with at least a 5-year follow-up after LDLT. We divided the study recipients into two groups: Group 1 (Tolerance Group) included recipients who achieved operational or prope tolerance for at least one year; Group 2 (Control Group) included recipients who did not achieve tolerance. We used logistic regression analysis to study the potential predictors of tolerance after LDLT.

Results: We included 368 recipients, 275 (74.7%) in Group 1 and 93 (25.3%) in Group 2. Operational tolerance occurred in 13/275 (4.7%) recipients and prope tolerance in 262/275 (95.3%) recipients. Age was significantly higher in Group 1. The median time for tolerance among the study recipients was 60 months (36-168). During follow-up, Group 1 showed lower serum levels of bilirubin, liver enzymes, alkaline phosphatase, and gamma-glutamyl transferase. Group 1 had a lower incidence of acute cellular rejection (ACR), recurrent viral hepatitis, and biliary complications. Logistic regression identified preoperative MELD, indication for LDLT, ACR, recurrent viral hepatitis, and biliary complications as significant predictors for allograft tolerance after LDLT.

Conclusion: Allograft tolerance occurred in 74.7% of this cohort. We suggest that the MELD score, indication for LT, ACR, recurrent viral hepatitis, and biliary complications are predictors of allograft tolerance after LDLT.

成人活体肝移植后同种异体移植耐受:一项病例对照研究。
背景:探讨成人活体肝移植(LDLT)受者免疫耐受的发生率及潜在预测因素。方法:本病例对照研究纳入了2004年5月至2018年1月期间接受LDLT治疗的成人受体,并在LDLT后进行了至少5年的随访。我们将研究接受者分为两组:第一组(耐受组)包括至少一年达到可操作或适当耐受的接受者;第2组(对照组)包括未达到耐受的受体。我们使用逻辑回归分析来研究LDLT后耐受性的潜在预测因素。结果:共纳入368例患者,1组275例(74.7%),2组93例(25.3%)。13/275例(4.7%)受者有操作耐受,262/275例(95.3%)受者有适当耐受。1组患者年龄明显增高。研究接受者耐受的中位时间为60个月(36-168)。随访期间,1组血清胆红素、肝酶、碱性磷酸酶和γ -谷氨酰转移酶水平较低。1组急性细胞排斥反应(ACR)、复发性病毒性肝炎和胆道并发症发生率较低。Logistic回归发现术前MELD、LDLT适应症、ACR、复发性病毒性肝炎和胆道并发症是LDLT后同种异体移植耐受的重要预测因素。结论:异体移植物耐受率为74.7%。我们认为MELD评分、肝移植适应症、ACR、复发性病毒性肝炎和胆道并发症是肝移植后同种异体移植耐受的预测指标。
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来源期刊
BMC Surgery
BMC Surgery SURGERY-
CiteScore
2.90
自引率
5.30%
发文量
391
审稿时长
58 days
期刊介绍: BMC Surgery is an open access, peer-reviewed journal that considers articles on surgical research, training, and practice.
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