How to Estimate the Probability of Tolerance Long-Term in Liver Transplant Recipients
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 ben...
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MDPI AG
2023-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/20/6546 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Dennis Eurich |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-10T21:09:39Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T21:09:39Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-33065a5925f54404951082ae93c4bc1e2023-11-19T16:52:38ZengMDPI AGJournal of Clinical Medicine2077-03832023-10-011220654610.3390/jcm12206546How to Estimate the Probability of Tolerance Long-Term in Liver Transplant RecipientsDennis Eurich0Stephan Schlickeiser1Ramin Raul Ossami Saidy2Deniz Uluk3Florian Rossner4Maximilian Postel5Wenzel Schoening6Robert Oellinger7Georg Lurje8Johann Pratschke9Petra Reinke10Natalie Gruen11Department of Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, GermanyBerlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charité—Universitätsmedizin Berlin, 13353 Berlin, GermanyDepartment of Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, GermanyDepartment of Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, GermanyDepartment of Pathology, Charité—Universitätsmedizin Berlin, 13353 Berlin, GermanyDepartment of Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, GermanyDepartment of Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, GermanyDepartment of Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, GermanyDepartment of Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, GermanyDepartment of Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, GermanyBerlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charité—Universitätsmedizin Berlin, 13353 Berlin, GermanyBerlin Center for Advanced Therapies (BeCAT), Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charité—Universitaetsmedizin Berlin, 13353 Berlin, GermanyBackground: 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.https://www.mdpi.com/2077-0383/12/20/6546liver transplantationoperational tolerancegraft lossimmunosuppressiongraft rejection |
| spellingShingle | 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 How to Estimate the Probability of Tolerance Long-Term in Liver Transplant Recipients Journal of Clinical Medicine liver transplantation operational tolerance graft loss immunosuppression graft rejection |
| title | How to Estimate the Probability of Tolerance Long-Term in Liver Transplant Recipients |
| title_full | How to Estimate the Probability of Tolerance Long-Term in Liver Transplant Recipients |
| title_fullStr | How to Estimate the Probability of Tolerance Long-Term in Liver Transplant Recipients |
| title_full_unstemmed | How to Estimate the Probability of Tolerance Long-Term in Liver Transplant Recipients |
| title_short | How to Estimate the Probability of Tolerance Long-Term in Liver Transplant Recipients |
| title_sort | how to estimate the probability of tolerance long term in liver transplant recipients |
| topic | liver transplantation operational tolerance graft loss immunosuppression graft rejection |
| url | https://www.mdpi.com/2077-0383/12/20/6546 |
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