Nomograms for Predicting the Incidence of Late-Onset Acute Cellular Rejection in Patients After Pediatric Liver Transplantation

Prediction model of the T cell-mediated rejection after liver transplantation in children and adults: A case-controlled study

OBJECTIVE

T cell-mediated rejection (TCMR) is a major concern following liver transplantation (LT), and identifying its predictors could help improve post-transplant prognosis. This study aimed to develop a model to predict the risk of TCMR in children and adults after LT.

METHOD

Pre-transplant demographic characteristics, intraoperative parameters, and especially early post-transplant laboratory data for 1221 LT recipients (1096 adults and 125 children) were obtained from the Hospital, University, between 1 January 2015, and 1 January 2022. These data were analyzed to develop the prediction model.

RESULT

The incidence of TCMR was higher in pediatric LT recipients than in adults (17.6% vs. 6.4%, P < 0.001). In adult recipients, seven predictors were identified: donor sex, recipient age, recipient height, and post-transplant levels of serum direct bilirubin, urea, platelets, and neutrophil-to-lymphocyte ratio. In pediatric recipients, four predictors were identified: post-transplant levels of serum monocyte percentage, direct bilirubin, albumin, and gamma-glutamyl transferase. The area under the model's curve incorporating these variables for predicting TCMR after LT was 0.713 (95% confidence interval, CI: 0.655-0.770) in adults and 0.786 (95% CI: 0.675-0.896) in children. Decision curve analyses demonstrated the clinical significance of the model.

CONCLUSION

This study developed a prediction model that may be useful in identifying high-TCMR-risk populations in both adult and pediatric LT recipients.

Imbalances of Th1/Th2 and Tc1/Tc2 are Associated With Active Cytomegalovirus Infection in Infant Liver Transplant Recipients

BACKGROUND

Because cytomegalovirus (CMV) infection is one of the most common complications following liver transplantation (LT), it is important to analyze the impact of CMV infection on the LT-associated changes in T cells polarization. This study aimed to investigate T helper (Th) and T cytotoxic (Tc) cells polarization and their correlation in infant LT recipients with active CMV infection.

METHODS

Twenty infant LT recipients with active CMV infection (the CMV group) and 20 recipients without CMV infection (the stable group) were enrolled. The percentages of Th1, Th2, Tc1, and Tc2 cells were detected by flow cytometry after intracellular staining for cytokines (IFN-γ and IL-10, respectively) in peripheral blood. The correlation between Th and Tc cells was analyzed by Pearson correlation coefficient.

RESULTS

The percentages of Th1 and Tc1 cells were significantly decreased, whereas the percentages of Tc2 cells were significantly increased in CMV group compared with the stable group, along with significant reduction of Th1/Th2 and Tc1/Tc2 ratios (P < .01). The percentages of Th1 cells were positively correlated with Tc1 cells (P < .01). A higher Th1/Th2 and Tc1/Tc2 ratios were showed in the CMV group after antiviral therapy than those in the CMV group before therapy (P < .01).

CONCLUSIONS

Our findings show an imbalanced Th1/Th2 and Tc1/Tc2 immunity in infant LT recipients with active CMV infection, which were involved in the pathogenesis of CMV infection.

Prediction of early recovery of graft function after living donor liver transplantation in children

For end-stage liver disease in children, living donor liver transplantation (LDLT) is often the important standard curative treatment. However, there is a lack of research on early recovery of graft function after pediatric LDLT. This is a single-center, ambispective cohort study. We collected the demographic and clinicopathological data of donors and recipients, and determined the risk factors of postoperative delayed recovery of hepatic function (DRHF) by univariate and multivariate Logistic analyses. 181 cases were included in the retrospective cohort and 50 cases in the prospective cohort. The incidence of DRHF after LDLT in children was 29.4%, and DRHF could well evaluate the early recovery of graft function after LDLT. Through Logistic analyses and AIC score, preoperative liver function of donors, ischemia duration level of the liver graft, Ln (Cr of recipients before operation) and Ln (TB of recipients on the 3rd day after operation) were predictive indicators for DRHF after LDLT in children. Using the above factors, we constructed a predictive model to evaluate the incidence of postoperative DRHF. Self-verification and prospective internal verification showed that this prediction model had good accuracy and clinical applicability. In conclusion, we pointed many risk factors for early delayed recovery of graft function after LDLT in children, and developed a visual and personalized predictive model for them, offering valuable insights for clinical management.