Introduction

Acute Cellular Rejection (ACR) affects 30 percent of all liver transplants. Histologically it is characterized by cellular inflammation in the veins, bile ducts and portal tracts. Cirrhosis is associated with a pro-inflammatory milieu. Patients with an increased baseline cytokine level would intuitively be more likely to develop ACR. Small studies in the pre-MELD era appear to support this hypothesis.

In this study we sought to characterize the cytokine milieu in ESLD candidates for OLT. Furthermore, we hypothesize that severity of liver failure correlates with elevated cytokine levels and therefore a higher incidence of rejection.

Methods

From January 2011-May 2015 we prospectively collected serum on day of transplant of patients who consented for the study and underwent OLT (n=150). Patients were divided into 2 groups – MELD<20 and MELD>20. Serum samples were analyzed by Luminex assays for leptin, adiponectin, IL-6, TNF-alpha, IL-8, IP-10, VEGF, and HGF. Demographics, MELD preop, and etiology were obtained. Pathology specimens with rejection were reviewed and scored per BANFF criteria. Student's t test, Chi-Square and Kaplan Meier curves were used as appropriate.

Results

No differences were noted in etiology.

Conclusions

These data show that elevated MELD scores in patients undergoing OLT is predictive of increased risk of rejection. Furthermore, this increase is likely caused by elevated cytokine levels preoperatively which lead to activation of innate immunity leading to an enhanced adaptive response.

CITATION INFORMATION: Mathur A, Presbyskowski E, Zorn E, Rogers K, Guarrera J, Samstein B, Griesemer A, Halazun K, Kato T, Emond J. Preoperative Cytokine Storm in High MELD Patients Accentuates Incidence of Rejection Following Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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