An objective definition for clinical suspicion of T-cell mediated rejection after liver transplantation

A uniform definition of clinical suspicion of T-cell mediated rejection (TCMR) in liver transplantation (LT) is needed to homogenize clinical decisions, especially within randomized trials. The present multicentre study included a total of 470 primary LT recipients. The derivation cohort consisted of 142 patients who had clinically-driven liver biopsies at any time after LT. The external validation cohort included 328 patients who underwent protocol biopsies at day 7-10 after LT. The rates of moderate-severe histological TCMR were 33.8% in the derivation cohort and 43.6% in the validation cohort. Independent predictors (ie. risk factors) of moderate-severe TCMR in the derivation cohort were: serum bilirubin >4mg/dL (OR=5.83; p 0.1*109/L (OR=3.81; p=0.004). In the validation cohort, the number of risk factors was an independent predictor of moderate-severe TCMR (OR=1.74; p=0.001), after controlling for hepatitis C status. The number of risk factors paralleled the rates of moderate-severe TCMR in the derivation and validation cohorts (p<0.001 in both comparisons). In conclusion, increased serum bilirubin, rising bilirubin and eosinophilia are validated risk factors for moderate-severe histological TCMR, and could be used as objective criteria to select candidates for liver biopsy. This article is protected by copyright. All rights reserved.