Late T cell–mediated rejection may contribute to poor outcomes in adolescents and young adults with liver transplantation

Abstract

Although poor long-term graft survival in LT in AYA is recognized, detailed epidemiological data are still lacking. L-TCMR may have poor outcomes. This study aimed to provide a detailed, epidemiological assessment of the association between AYA age and rejection. L-TCMR was defined in this study as TCMR with central vein or perivenular inflammation occurring later than 3 months after LT. A total of 342 patients who survived for at least 3 months after LT between 2005 and 2015 were enrolled.The AYA group (10-24 years) was compared with the C group (less than 10 years), and the incidence and outcomes of L-TCMR were analyzed. In total, 342 patients had LT; 38 of these were AYA with the mean follow-up period of 6.7 years. A total of 304 patients in C group had a mean follow-up period of 6.3 years (P = .28). The incidence of L-TCMR in AYA group was significantly higher than in C group (15.8% vs 4.6%, P = .006). The time to L-TCMR after LT was significantly shorter in AYA group (P = .01). Neither patient survival nor the incidence of non-adherence differed significantly between the groups (P = .18 and P = .89). The number of additional immunosuppressants after L-TCMR was significantly higher in the AYA group (P = .04). A high incidence of L-TCMR was observed in AYA group irrespective of non-adherence. AYA patients with L-TCMR should be followed carefully due to the poor results of posttreatment biopsy and the need for intensive immunosuppressive therapy. K E Y W O R D Sadolescent and young adult, late T cell-mediated rejection, liver transplantation

Belatacept Treatment of Recurrent Late-onset T Cell–mediated Rejection/Antibody-mediated Rejection With De Novo Donor-specific Antibodies in a Liver Transplant Patient

“…[2][3][4] Additionally, young adults (10-24 y old) have a significantly higher incidence of late TCMR than controls. 5 Current treatment recommendations for late-onset/persistent TCMR generally include an algorithmic stepwise approach: (1) corticosteroids; (2) increased calcineurin inhibitors; (3) calcineurin inhibitor conversion (eg, from cyclosporine to tacrolimus); (4) addition of an antimetabolite (azathioprine or mycophenolate); and (5) antilymphocyte antibody therapy. [2][3][4] One group even resorted to local allograft irradiation.…”

“…2-4 Additionally, young adults (10–24 y old) have a significantly higher incidence of late TCMR than controls. 5…”