Prediction Model of the T Cell-mediated Rejection After Liver Transplantation in Children and Adults: a Case-controlled Study

Objective: T cell-mediated rejection (TCMR) is a major concern following liver transplantation (LT), and identifying its predictors could help improve post-transplant prognosis. This study aimed to develop a model to predict the risk of TCMR in children and adults after LT. Method: Pre-transplant demographic characteristics, intraoperative parameters, and especially early post-transplant laboratory data for 1,221 LT recipients (1,096 adults and 125 children) were obtained from Hospital, University, between 1 January 2015, and 1 January 2022. These data were analyzed to develop the prediction model. Result: The incidence of TCMR was higher in pediatric LT recipients than in adults (17.6% vs. 6.4%, p < 0.001). In adult recipients, seven predictors were identified: donor sex, recipient age, recipient height, and post-transplant levels of serum direct bilirubin, urea, platelets, and neutrophil-to-lymphocyte ratio. In pediatric recipients, four predictors were identified: post-transplant levels of serum monocyte percentage, direct bilirubin, albumin, and gamma-glutamyl transferase. The area under the model’s curve incorporating these variables for predicting TCMR after LT was 0.713 (95% CI: 0.655-0.770) in adults and 0.786 (95% CI: 0.675-0.896) in children. Decision curve analyses demonstrated the clinical significance of the model. Conclusion: This study developed a prediction model that may be useful in identifying high-TCMR-risk populations in both adult and pediatric LT recipients.