Habl Mohamed S, Emara Moataz Maher, Zayed Reham A, Sultan Ahmed M, Elsabagh Ahmed, Elsaid Ahmed Marwan, Abdel-Khalek Ehab E, El-Saadany Mohamed M, Wahab Mohamed Abdel, Shehta Ahmed
Department of Hepatology and Gastroenterology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Department of Anesthesiology and Intensive Care and Pain Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
BMC Surg. 2025 Jan 30;25(1):52. doi: 10.1186/s12893-025-02780-5.
To investigate the incidence and potential predictors of immune tolerance among adult living donor liver transplant (LDLT) recipients.
This case-control study included adult recipients who underwent LDLT between May 2004 and January 2018, with at least a 5-year follow-up after LDLT. We divided the study recipients into two groups: Group 1 (Tolerance Group) included recipients who achieved operational or prope tolerance for at least one year; Group 2 (Control Group) included recipients who did not achieve tolerance. We used logistic regression analysis to study the potential predictors of tolerance after LDLT.
We included 368 recipients, 275 (74.7%) in Group 1 and 93 (25.3%) in Group 2. Operational tolerance occurred in 13/275 (4.7%) recipients and prope tolerance in 262/275 (95.3%) recipients. Age was significantly higher in Group 1. The median time for tolerance among the study recipients was 60 months (36-168). During follow-up, Group 1 showed lower serum levels of bilirubin, liver enzymes, alkaline phosphatase, and gamma-glutamyl transferase. Group 1 had a lower incidence of acute cellular rejection (ACR), recurrent viral hepatitis, and biliary complications. Logistic regression identified preoperative MELD, indication for LDLT, ACR, recurrent viral hepatitis, and biliary complications as significant predictors for allograft tolerance after LDLT.
Allograft tolerance occurred in 74.7% of this cohort. We suggest that the MELD score, indication for LT, ACR, recurrent viral hepatitis, and biliary complications are predictors of allograft tolerance after LDLT.
探讨成人活体肝移植（LDLT）受者免疫耐受的发生率及潜在预测因素。
本病例对照研究纳入了2004年5月至2018年1月期间接受LDLT的成年受者，LDLT术后至少随访5年。我们将研究受者分为两组：第1组（耐受组）包括实现手术或准耐受至少1年的受者；第2组（对照组）包括未实现耐受的受者。我们采用逻辑回归分析研究LDLT后耐受的潜在预测因素。
我们纳入了368名受者，第1组275名（74.7%），第2组93名（25.3%）。13/275名（4.7%）受者发生手术耐受，262/275名（95.3%）受者发生准耐受。第1组年龄显著更高。研究受者耐受的中位时间为60个月（36 - 168个月）。随访期间，第1组血清胆红素、肝酶、碱性磷酸酶和γ-谷氨酰转移酶水平较低。第1组急性细胞排斥反应（ACR）、复发性病毒性肝炎和胆道并发症的发生率较低。逻辑回归确定术前终末期肝病模型（MELD）评分、LDLT适应证、ACR、复发性病毒性肝炎和胆道并发症是LDLT后移植物耐受的重要预测因素。
该队列中74.7%的患者发生了移植物耐受。我们认为MELD评分、肝移植适应证、ACR、复发性病毒性肝炎和胆道并发症是LDLT后移植物耐受的预测因素。
