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Background <p>Infections are a leading cause of early mortality after liver transplantation (LT). Prior to transplantation, cirrhosis-associated immune dysfunction significantly increases the risk of infection. This study investigated the potential of immune monitoring, with a focus on monocytic HLA-DR (mHLA-DR) expression, as a predictor of post-LT complications.</p> Methods <p>We conducted a prospective study on 130 patients awaiting LT at Lyon University Hospital to assess mHLA-DR expression, lymphocyte subsets, and T-cell function before and after LT. Multivariate analysis and K-means longitudinal clustering were performed to explore the relationships between immune trajectories and clinical outcomes.</p> Results <p>Among the 99 patients who underwent LT, 35.4% experienced infections early post-LT. No difference in outcome was found regarding lymphocyte count or function. Delayed mHLA-DR recovery (Day 7 &lt; 11,000 AB/C) and pre-LT MELD scores &gt; 30 emerged as independent infection risk factors, with ORs of 12.1 [4.4–38.2], <i>p</i> &lt; 0.0001 and 4.9 [1.4–18.4], <i>p</i> = 0.01, respectively. Patients with delayed mHLA-DR restoration also had reduced one-year survival (77.8% versus 98.3%, <i>p</i> = 0.003). K-means clustering revealed three distinct mHLA-DR recovery profiles, with the slowest recovery group showing the poorest outcomes.</p> Conclusions <p>Our findings highlight mHLA-DR as an early predictor of post-LT infections. Monitoring post-LT immune function through mHLA-DR expression could guide individualized management strategies to improve outcomes.</p> <p><i>Trial registration</i> The study was registered in the ClinicalTrials.gov registry: NCT03995537, date: June 20, 2019.</p>

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Individual mHLA-DR trajectories in the ICU as predictors of early infections following liver transplantation: a prospective observational study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月18日

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  • M. C. Delignette,
  • A. Riff,
  • T. Antonini,
  • T. Soustre,
  • M. Bodinier,
  • E. Peronnet,
  • F. Venet,
  • M. Gossez,
  • S. Pantel,
  • J. Y. Mabrut,
  • X. Muller,
  • K. Mohkam,
  • F. Villeret,
  • D. Erard,
  • J. Dumortier,
  • F. Zoulim,
  • L. Heyer,
  • C. Guichon,
  • A. Blet,
  • F. Aubrun,
  • G. Monneret,
  • F. Lebossé

摘要

Background

Infections are a leading cause of early mortality after liver transplantation (LT). Prior to transplantation, cirrhosis-associated immune dysfunction significantly increases the risk of infection. This study investigated the potential of immune monitoring, with a focus on monocytic HLA-DR (mHLA-DR) expression, as a predictor of post-LT complications.

Methods

We conducted a prospective study on 130 patients awaiting LT at Lyon University Hospital to assess mHLA-DR expression, lymphocyte subsets, and T-cell function before and after LT. Multivariate analysis and K-means longitudinal clustering were performed to explore the relationships between immune trajectories and clinical outcomes.

Results

Among the 99 patients who underwent LT, 35.4% experienced infections early post-LT. No difference in outcome was found regarding lymphocyte count or function. Delayed mHLA-DR recovery (Day 7 < 11,000 AB/C) and pre-LT MELD scores > 30 emerged as independent infection risk factors, with ORs of 12.1 [4.4–38.2], p < 0.0001 and 4.9 [1.4–18.4], p = 0.01, respectively. Patients with delayed mHLA-DR restoration also had reduced one-year survival (77.8% versus 98.3%, p = 0.003). K-means clustering revealed three distinct mHLA-DR recovery profiles, with the slowest recovery group showing the poorest outcomes.

Conclusions

Our findings highlight mHLA-DR as an early predictor of post-LT infections. Monitoring post-LT immune function through mHLA-DR expression could guide individualized management strategies to improve outcomes.

Trial registration The study was registered in the ClinicalTrials.gov registry: NCT03995537, date: June 20, 2019.