Vnitřní lékařství 1/2020

PŮVODNÍ PRÁCE Prevalence and risk factors of T-cell mediated rejection in patients after liver transplantation from deceased donors: a retrospective study over 10 years 6 | VNITŘNÍ LÉKAŘSTVÍ / Vnitř Lék 2020; 66(E-1): 4–10 /  www.casopisvnitrnilekarstvi.cz serum bilirubin following liver transplantation or evidence of worsening liver function. To confirm the diagnosis of TCMR, patients underwent percutaneous liver biopsy under ultrasound guidance using a true-cut needle (n = 12). In cases having contraindications to percutaneous liver biopsy (platelet count lower than 50 000 × 10 9 /l), trans-jugular liver biopsy (n = 9) was carried out. All patients reported an early form of TCMR histologically diagnosed at an interval of up to three months after LTx. Once TCMR was histologically confirmed, we treated patients with intravenous pulses of methylprednisolone with a cumulative dose of 3 grams (1 000 mg/day/3 days). In cases with inadequate response to steroids (a mild form of TCMR), we labeled TCMR as cortico-resistant, and patients received intravenous anti-thymocyte globulin (ATG) at a dose of 2.5–5 mg/kg/day for 14 days (a moderate and severe form of TCMR). Statistical analysis was performed using a software package MedCalc v.18, Ostende, Belgium. We present all the numerical para- meters as mean and standard deviation, categorical variables as per- centages. Comparison of TCMR and no-TCMR groups was performed using T-test in normally distributed variables, Mann-Whitney-test in non-normally distributed variables and chi-square test in comparing proportions. To identify factors independently associated with TCMR, we entered all parameters appearing statistically associated with TCMR (p < 0.12) into a backward multivariate logistic regression. We analyzed the overall survival between sexes and TCMR and no-TCMR groups with Kaplan-Meier survival curves. Statistical significance was defined by the probability of null-hypothesis inferior to 0.05. The study has been carried out following the proceedings of the Helsinki declaration. All the patients have signed an informed consent before any procedure, and separately for liver transplantation. The study has a retrospective design; data were anonymized in the database and patients did not undergo any intervention apart from the usual proce- dures prior and post liver transplantation. All authors declare having no conflicts of interest. Dataset for this observational study is available on request from authors. Results During the reporting period, 196 consecutive DDLT were performed including 3 re-transplantations. The final analysis included 184 pati- ents. Summary statistics and study group characteristics are displayed in table 1. Mean age was 53.6 (43.4–59.4), 41.3 % were females, with average MELD score 16.0 (13.5–18.8) points, mean Child-Pugh score 10.0 (8–11) points. TCMR was diagnosed in 21 patients (11.4 %). Each of the patients had only one episode of TCMR. Six patients adequately responded to steroid pulse therapy, histologically, this was a mild form of TCMR. In 15 patients, the response was not adequate and they received second-line therapy with ATG, histologically, these were a mild and severe form of Tab. 1.  Summary statistics and baseline characteristics of the study group of 184 patients after liver transplantation fromdeceased donors N = 184 Median/% Inter-quartile range Demography age 53.6 43.4–59.4 % of women 41.3 BMI (kg/m2) 26.1 23.3–29.0 Etiology of cirrhosis % alcohol 47.8 % viral etiology 12 % NAFLD 10.3 % AIH 9.8 % PBC 8.7 % PSC 8.2 % Wilson disease 2.2 % HCC 10.3 ESLD characteristic Child Pugh score 10 8–11 MELD score 16 13.5–18.8 INR 1.49 1.4–1.6 Serum creatinine (μmol/l) 72 60.0–88.5 Serum bilirubin (μmol/l) 51.3 35.3–96.6 Serum albumin (g/l) 30.0 26.0–34.3 Clinical ascites (%) 75.4 PSE (%) 59.9 Blood grop (BG) % BG_0 23.9 % BG_A 48.9 % BG_AB 12,0 % BG_B 15.2 % Rh_posit 83.7 Transplantation Tacrolimus level Day 5 5.80 3.7–9.1 Tacrolimus level on discharge 8.9 6.90–11.3 Cold ischemia time (min.) 377.5 355.0–415.0 % Acute cellular rejection 11.4 Follow-up time – moths after LTx 37.4 15.2–71.5 NAFLD – non alcoholic fatty liver disease, AIH – aAutoimmune hepatitis, PBC – pPrimary biliary cholangitis, PSC – primary sclerosisg cholangitis, HCC – hepatocellular carcinoma, PSE – portosystemic encephalopathy