Prognostic model for early acute rejection after liver transplantation



Hepatic graft rejection is a common complication after liver transplantation (LT), with a maximum incidence within the first weeks. The identification of high-risk patients for early acute rejection (EAR) might be useful for clinicians. A series of 133 liver graft recipients treated with calcineurin inhibitors was retrospectively assessed to identify predisposing factors for EAR and develop a mathematical model to predict the individual risk of each patient. The incidence of EAR (≤45 days after LT) was 35.3%. Multivariate analysis showed that recipient age, underlying liver disease, and Child's class before LT were independently associated with the development of EAR. Combining these 3 variables, the following risk score for the development of EAR was obtained: EAR score [F(x)] = 2.44 + (1.14 × hepatitis C virus cirrhosis) + (2.78 × immunologic cirrhosis) + (2.51 × metabolic cirrhosis) − (0.08 × recipient age in years) + (1.65 × Child's class). Risk for rejection = eF(x)/1 + eF(x). The combination of age, cause of liver disease, and Child's class may allow us to predict the risk for EAR.