Internal Validation of a Pre-Transplant Biomarker Panel to Predict Post-Transplant Mortality: The Liver Immune Frailty Index
1Rutgers New Jersey Medical School, Newark, NJ, 2Houston Methodist Hospital, Houston, TX
Meeting: 2022 American Transplant Congress
Abstract number: 418
Keywords: Immune deviation, Inflammation, Liver transplantation, Survival
Topic: Clinical Science » Liver » 55 - Liver: Recipient Selection
Session Information
Session Name: Recipient Selection
Session Type: Rapid Fire Oral Abstract
Date: Tuesday, June 7, 2022
Session Time: 3:30pm-5:00pm
Presentation Time: 3:30pm-3:40pm
Location: Hynes Room 312
*Purpose: Infection and sepsis are the greatest contributors to early post-liver transplant (LT) mortality. These often result from ongoing immune dysfunction, or “Immune Frailty”. We have previously explored pre-LT biomarkers predicting post-LT mortality, the Liver Immune Frailty Index (LIFI). This study expands initial observations and performs internal validation of LIFI to predict post-LT mortality.
*Methods: Plasma from 262 LT recipients was analyzed on POD-0 via Luminex. Clinical data was correlated with 24 chemokines/cytokines (sIL6rβ, GCP-2, CCL1, SDF, MMP2, TNF-α, BAFF, Eotaxin, MMP3, IP-10, IL-10, CTACK, Fractalkine, GM-CSF, IFN-γ, IL-1β, IL-2, IL-4, IL-5, IL-6, IL7, IL-8, IL-12, IL-13).
*Results: Cox-proportional hazard clinically correlated pre-LT sIL6rβ, MMP2, BAFF, Eotaxin, MMP3, Fractalkine, IL-1β, and IL-2 elevation with 1yr post-LT mortality (p<0.05). Multivariate analysis identified HCV IgG, Eotaxin, and Factalkine as pre-LT predictors of 1yr post-LT mortality (c-statistic=0.86). LIFI was calculated by assigning weighted points proportional to covariate ß-coefficients multiplied by 10. LIFI-low, -moderate, and -high were categorized based on tertiles. Internal validation demonstrated a c-statistic=0.82 (Figure 1). LIFI-low recipients have a 2.9% 1yr mortality compared with 50% for LIFI-high (Figure 2).
*Conclusions: The LIFI score can predict post-LT mortality risk for a candidate immediately prior to LT. Immune Frailty likely directly relates to pre-LT alterations to the immune system, resulting from underlying cirrhosis and progressive sarcopenia. The inability to recover normal immune function after LT likely increases risk of infection, cancer recurrence, and ultimately death. The LIFI score may be a useful tool to augment patient assessment and stratification prior to LT.
To cite this abstract in AMA style:
Panayotova GG, Nguyen DT, Graviss EA, Minze LJ, Simonishvili S, Qin Y, Ayorinde T, Prakash G, Paterno F, Brown L, Amin A, Li XC, Ghobrial RM, Guarrera JV, Lunsford KE. Internal Validation of a Pre-Transplant Biomarker Panel to Predict Post-Transplant Mortality: The Liver Immune Frailty Index [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/internal-validation-of-a-pre-transplant-biomarker-panel-to-predict-post-transplant-mortality-the-liver-immune-frailty-index/. Accessed October 3, 2024.« Back to 2022 American Transplant Congress