Noninvasive markers identify LT recipients eligible for immunosuppression taper

04 Sep 2021

Noninvasive markers, including alanine aminotransferase (ALT) and liver stiffness measurements (LSM), may help distinguish liver transplant (LT) recipients for whom minimizing immunosuppression would be safe, a recent study has found.

Researchers conducted a cross-sectional analysis of 190 adult LT recipients (median age 61 years, 66 percent men) with stable allograft function and who were under evaluation for eligibility for an immunosuppression withdrawal trial. Participants underwent biochemical, haematological, and serological examinations at inclusion, as well as transient elastography, human leukocyte antigen typing, and liver biopsies.

Biopsies from 122 patients (64.2 percent) showed no or minimal allograft damage, making them eligible to consider for immunosuppression minimization, according to the Banff Working Group on Liver Allograft Pathology. The remaining 68 patients (35.8 percent) were deemed unsuitable for withdrawal, with their grafts exhibiting high grades of inflammation, hepatitis, and fibrosis.

Binary logistic regression analysis revealed that baseline levels of ALT and LSM were significantly and independently associated with alloimmune damage. Receiver operating characteristic curve analysis showed that a model incorporating both factors had good discriminative value, with an area under the curve of 0.82.

In particular, patients with ALT ≤15 U/L were at very low risk of having alloimmune damage, while those with concentrations >34 U/L had a 45-percent chance of having such damage. In patients with intermediate ALT levels (15–34 U/L), LSM proved helpful in stratifying according to risk of alloimmune damage.

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