Abstract
Acute cellular rejection (ACR) after liver transplantation (LT) goes along with allograft dysfunction, which is diagnosed by liver biopsy and concomitant histological analysis, representing the gold standard in clinical practice. Yet, liver biopsies are invasive, costly, time-intensive and require expert knowledge. Herein we present substantial evidence that blood plasma residing peripheral liver-derived extracellular particles (EP) could be employed to diagnose ACR non-invasively. In vitro experiments showed organ-specific EP release from primary human hepatocytes under immunological stress. Secondly, analysis of consecutive LT patients (n=11) revealed significant heightened EP concentrations days before ACR. By conducting a diagnostic accuracy study (n = 69, DRKS00011631), we explored the viability of using EP as a liquid biopsy for diagnosing ACR following LT. Consequently, novel EP populations in samples were identified using visualization of t-distributed stochastic neighbor embedding (viSNE) and self-organizing maps (FlowSOM) algorithms. As a result, the ASGR1+CD130+Annexin V+ EP subpopulation exhibited the highest accuracy for predicting ACR (area under the curve: 0.80, 95% confidence interval [CI], 0.70–0.90), with diagnostic sensitivity and specificity of 100% (95% CI, 81.67–100.0%) and 68.5% (95% CI, 55.3–79.3%), respectively. In summary, this new EP subpopulation presented the highest diagnostic accuracy for detecting ACR in LT patients.
Highlights
Liver transplantation (LT) is the treatment of choice for patients with end-stage liver disease, acute liver failure, metabolic disorders, and selected liver tumors [1]
We have previously shown that CD4+, CD8+ and CD31+ Extracellular particles (EP) elevated in patients at risk for acute cellular rejection (ACR) [6]
There was a significant increase in CD130+ (/μl) (p = 0.003), connexin 43 (Cx43)+ (/ml) (p = 0.026) and Asialoglycoprotein Receptor 1 (ASGR1)+ (/μl) (p = 0.024) EP accompanied with an increasing trend of Ann V+ (/μl) EP
Summary
Liver transplantation (LT) is the treatment of choice for patients with end-stage liver disease, acute liver failure, metabolic disorders, and selected liver tumors [1]. Every LB presents the risk of severe complications such as graft damage, infection, bleeding, and thrombosis, which is why LBs are controversial in terms of monitoring graft function and remain inconvenient due to the considerable time required and the need for a specialist to perform the biopsy [5]. Their diagnostic potential is heavily constrained by the high inter-observer variation among pathologists in the grading and the quality of the specimen. Non-invasive and accurate monitoring tools can play an essential role in diagnosing ACR and individual postoperative care adaptation
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