Identification of Adult Liver Transplant Recipients Eligible to Participate in an Immunosuppression Withdrawal Trial Employing Non-Invasive Assessments of Allograft Status

J. Vionnet¹, R. Miquel¹, A. Douiri¹, M. Elstad¹, E. Kodela¹, A. Quaglia², J. Wall¹, P. Ruiz Martin¹, E. B. Riani³, J. Leithead⁴, A. Marshall², M. Navasa⁵, P. Ruiz⁵, J. Ferguson⁶, K. Simpson⁷, A. Pascher⁸, E. Jaeckel⁹, R. Bishop¹⁰, F. Nevens¹¹, S. Masson¹², A. Sanchez-Fueyo¹

¹King's College London, London, United Kingdom, ²Royal Free, London, United Kingdom, ³St-Luc, Brussels, Belgium, ⁴Addenbrookes, Cambridge, United Kingdom, ⁵Hospital Clinic, Barcelona, Spain, ⁶Queen Elizabeth, Birmingham, United Kingdom, ⁷Royal Infirmary, Edinburgh, United Kingdom, ⁸Charité, Berlin, Germany, ⁹Hannover Medical School, Hannover, Germany, ¹⁰Leeds NHS Trust, Leeds, United Kingdom, ¹¹UZ Leuven, Leuven, Belgium, ¹²Hepatology, Newcastle, United Kingdom

Meeting: 2019 American Transplant Congress

Abstract number: D352

Keywords: Immunosuppression, Liver transplantation, Tolerance

Session Information

Session Name: Poster Session D: Tolerance: Clinical Studies

Session Type: Poster Session

Date: Tuesday, June 4, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: Liver Immunosuppression Free Trial (LIFT) is a multicentre international prospective randomised controlled trial of biomarker-guided immunosuppression withdrawal in adult liver transplant recipients who meet the following criteria: >3 years post-transplant, normal liver function, no autoimmune or replicative viral disease, no significant inflammatory/fibrotic histological lesions.

*Methods: Between 11/2015 and 11/2018, 151 patients underwent a screening liver biopsy to determine histological eligibility. Additional baseline assessments included liver tissue gene expression, liver stiffness measurement (LSM, FibroScan) and circulating anti-HLA antibodies. Two central pathologists evaluated all biopsies.

*Results: Out of the 151 biopsies, 95 (63%) met histological eligibility and 56 (37%) did not. Main histological differences between eligible and non-eligible patients are described in Image 1. Non-eligible patients had a higher mean LSM than eligible patients (7,5 vs 4,5 kPa; p=0.001) despite no differences in liver biochemistry. LSM exhibited a good discrimination capacity with AUC=0,84. Each 1 kPa increase in LSM raised the odds ratio of being non-eligible by 2,28 (p=0.001). Moreover, the use of a LSM cut-off of >8,3 kPa identified non-eligibility with PPV=100%, NPV=70%, Sn=31%, and Sp=100%.

*Conclusions: A large proportion of adult stable liver recipients with normal liver tests exhibit subclinical histological abnormalities that preclude their eligibility to participate in an immunosuppression withdrawal trial. In this population, LSM could be a useful non-invasive tool to stratify patients prior to performing surveillance liver biopsies.

To cite this abstract in AMA style:

Vionnet J, Miquel R, Douiri A, Elstad M, Kodela E, Quaglia A, Wall J, Martin PRuiz, Riani EB, Leithead J, Marshall A, Navasa M, Ruiz P, Ferguson J, Simpson K, Pascher A, Jaeckel E, Bishop R, Nevens F, Masson S, Sanchez-Fueyo A. Identification of Adult Liver Transplant Recipients Eligible to Participate in an Immunosuppression Withdrawal Trial Employing Non-Invasive Assessments of Allograft Status [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/identification-of-adult-liver-transplant-recipients-eligible-to-participate-in-an-immunosuppression-withdrawal-trial-employing-non-invasive-assessments-of-allograft-status/. Accessed November 22, 2024.

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