The risk factors to predict acute rejection in liver transplantation

Purpose: The aim of this study was to evaluate risk factors for an acute cellular rejection episode (ARE) among adult liver transplant (OLT) patients. Materials and methods: We retrospectively reviewed 110 consecutive patients who underwent OLT between May 2007 and December 2010. The diagnosis of ARE was based upon clinical and biochemical data; liver biopsy was only performed when clinical presentation was equivocal. We recorded donor and recipient characteristics, perioperative immune status, and postoperative laboratory data. Forty patients (36.4%) who suffered a clinical rejection episode and received pulsed or recycled steroid therapy (R group), were compared with 70 (63.6%) free of rejection (N group). Results: The mean age of R recipients was 46.61 ± 9.97 years, which was younger than the N group (51.86 ± 8.37, P =.005). R group patients displayed a lower pre-OLT creatinine (P =.016) and higher alanine aminotransferase (P =.048). Cox regression model showed recipient age to be the only significant factor to predict ARE (odds ratio = 1.071, P =.003). The cutpoint of age was 46 years by receiver operating characteristic analysis. Patients younger than 46 years showed higher initial CD8 ⁺ T-cell counts (P =.038). Conclusion: Recipient age was significantly associated with ARE; younger patients showed higher CD8 ⁺ lymphocyte counts than older patients. More aggressive immunosuppression should be considered for younger recipients to prevent ARE.