Recipient Gender and Body Mass Index are Associated with Early Acute Rejection in Donation after Cardiac Death Liver Transplantation

Abstract

Background: Early acute rejection (EAR) is a common complication after liver transplantation (LT). The purpose of this study was to evaluate the incidence and risk factors of EAR in donation after cardiac death (DCD) liver transplantation recipients. Methods: We retrospectively analyzed the data of 461 DCD liver transplants performed during the period from January 2010 to June 2016 to study the relationship between EAR and various clinical factors. EAR was defined as histologically proven acute cellular rejection occurring less than 90 days after transplantation. Findings: The median follow-up time for this study was 33.1 months (range, 0.03-92.8months). Thirty-two (6.9%) patients developed EAR with a median period of 20.5 days (5-88 days) after transplantation. A multivariate analysis revealed that female recipient (hazard ratio, 2.801; P = 0.024) and high recipient body mass index (BMI) (hazard ratio, 1.005; P = 0.049) were two independent risk factors for early acute rejection. A multivariate analysis was performed in order to evaluate the factors that influenced the overall survival, the result revealed that HCC (hazard ratio, 2.308；P <0.001), ABO-incompatibility (hazard ratio, 1.793；P =0.001) and operation time≥360 minutes (hazard ratio, 1.627; P = 0.012) were the independent prognostic factors for overall survival after liver transplantation. Interpretation: Recipients' gender and BMI are related to early acute rejection in DCD liver transplant. HCC, ABO-incompatibility and OT ≥360 minutes are the independent prognostic factors for overall survival. Funding Statement: This work was supported by grants from National Natural Science Foundation of China (Grant No. 81800578), the Changjiang Scholar Program of Chinese Ministry of Education (No. T2014146) and National S&T Major Project (No. 2017ZX10203205). Declaration of Interests: The authors who have taken part in this study declare that they do not have any potential conflicts (financial, professional, or personal) that are relevant to the manuscript. Ethics Approval Statement: Each organ donation and transplantation strictly followed the guidelines of the Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine, the current regulation of the Chinese Government and the Declaration of Helsinki.