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How to Estimate the Probability of Tolerance Long-Term in Liver Transplant Recipients

Authors :
Dennis Eurich
Stephan Schlickeiser
Ramin Raul Ossami Saidy
Deniz Uluk
Florian Rossner
Maximilian Postel
Wenzel Schoening
Robert Oellinger
Georg Lurje
Johann Pratschke
Petra Reinke
Natalie Gruen
Source :
Journal of Clinical Medicine, Vol 12, Iss 20, p 6546 (2023)
Publication Year :
2023
Publisher :
MDPI AG, 2023.

Abstract

Background: Operational tolerance as the ability to accept the liver transplant without pharmacological immunosuppression is a common phenomenon in the long-term course. However, it is currently underutilized due to a lack of simple diagnostic support and fear of rejection despite its recognized benefits. In the present work, we present a simple score based on clinical parameters to estimate the probability of tolerance. Patients and methods: In order to estimate the probability of tolerance, clinical parameters from 82 patients after LT who underwent weaning from the IS for various reasons at our transplant center were extracted from a prospectively organized database and analyzed retrospectively. Univariate testing as well as multivariable logistic regression analysis were performed to assess the association of clinical variables with tolerance in the real-world setting. Results: The most important factors associated with tolerance after multivariable logistic regression were IS monotherapy, male sex, history of hepatocellular carcinoma pretransplant, time since LT, and lack of rejection. These five predictors were retained in an approximate model that could be presented as a simple scoring system to estimate the clinical probability of tolerance or IS dispensability with good predictive performance (AUC = 0.89). Conclusion: In parallel with the existence of a tremendous need for further research on tolerance mechanisms, the presented score, after validation in a larger collective preferably in a multicenter setting, could be easily and safely applied in the real world and already now address all three levels of prevention in LT patients over the long-term course.

Details

Language :
English
ISSN :
20770383
Volume :
12
Issue :
20
Database :
Directory of Open Access Journals
Journal :
Journal of Clinical Medicine
Publication Type :
Academic Journal
Accession number :
edsdoj.33065a5925f54404951082ae93c4bc1e
Document Type :
article
Full Text :
https://doi.org/10.3390/jcm12206546