Session Name: Post Liver Transplant Management and Complications
Date: Tuesday, June 8, 2021
Session Time: 4:30pm-5:30pm
Presentation Time: 4:35pm-4:40pm
*Purpose: Existing literature offers conflicting conclusions about whether early acute cellular rejection influences long-term outcomes in liver transplantation.
*Methods: We retrospectively collected donor and recipient data on 813 adult, first-time liver transplants performed at a single center between 2009 and 2019. We divided this population into two cohorts based on the presence of early biopsy-proven acute cellular rejection (EBPR) within the first 12 weeks post-transplant and compared outcomes (overall survival, death censored graft survival (DCGS), infection and long-term rejection rates) between the groups. Kaplan-Meier estimates were used to assess time to first event with p value < 0.05 for significance.
*Results: Of the 813 liver transplants, 97 (12%) met inclusion criteria of EBPR. Donor and recipient characteristics did not differ between patients with and without EBPR (Tables 1).
|Characteristic||Early biopsy-proven rejection (n=97)||No early rejection (n=716)||p-value|
|Recipient age||54 (52-57)||55 (55-56)||
|Recipient female||28% (27)||30% (231)||
|Recipient BMI||31 (29-32)||30 (29-31)||
|Use of induction agent||15% (15)||19% (133)||0.57|
|Donor age||45 (43-48)||45 (44-46)||
|Donor female||43% (42)||39% (276)||0.37|
|Donor BMI||29 (28-31)||28 (28-29)||0.21|
Recipients with EBPR had similar overall survival compared to patients without EBPR (p=0.29), but had inferior one year death-censored graft survival (95.8% for EBPR vs. 98.7% for no EBPR, p<0.05). EBPR was also associated with decreased time to first episode of late (>12 weeks post-transplant) rejection (p<0.0001, Fig 1).
Recipients with EBPR had increased rates of bacterial and viral infection (p<0.05, Fig 2).
*Conclusions: EBPR after liver transplant is associated with inferior death-censored graft survival, increased susceptibility to late rejections, and increased vulnerability to infection. Identifying strategies to mitigate EBPR may lead to improved long-term outcomes after liver transplantation.
To cite this abstract in AMA style:Aufhauser DD, Marka N, Stalter L, Levenson G, Al-Adra D, Foley DP. Effect of Early Biopsy-Proven Rejection on Liver Transplant Outcomes [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/effect-of-early-biopsy-proven-rejection-on-liver-transplant-outcomes/. Accessed August 3, 2021.
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