Graft survival beyond year 1 has not changed after orthotopic liver transplantation (OLT) over the last decades. Likewise, OLT causes comorbidities such as infection, renal impairment and cancer. We evaluated our single-center real-world individualized immunosuppression program after OLT, based on 211 baseline surveillance biopsies (svLbx) without any procedural complications. Patients were classified as low, intermediate and high rejection risk based on graft injury in svLbx and anti-HLA donor-specific antibodies. While 32% of patients had minimal histological inflammation, 57% showed histological inflammation and 23% advanced fibrosis (>F2), which was not predicted by lab parameters. IS was modified in 79% of patients after svLbx. After immunosuppression reduction in 69 patients, only 5 patients showed ALT elevations and three of these patients had a biopsy-proven acute rejection, two of them related to lethal comorbidities. The rate of liver enzyme elevation including rejection was not significantly increased compared to a svLbx control cohort prior to the initiation of our structured program. Immunosuppression reduction led to significantly better kidney function compared to this control cohort. In conclusion, a biopsy guided personalized immunosuppression protocol after OLT can identify patients requiring lower immunosuppression or patients with graft injury in which IS should not be further reduced.

中文翻译：

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肝移植后监测活检指导个性化免疫抑制方案的结果和安全性

在过去几十年中，原位肝移植 (OLT) 后 1 年后的移植物存活率没有改变。同样，OLT 会导致合并症，例如感染、肾功能损害和癌症。我们基于 211 例基线监测活检 (svLbx) 评估了 OLT 后我们的单中心真实世界个体化免疫抑制计划，没有任何程序并发症。根据 svLbx 中的移植物损伤和抗 HLA 供体特异性抗体，将患者分为低、中和高排斥风险。虽然 32% 的患者有轻微的组织学炎症，但 57% 的患者表现出组织学炎症和 23% 的晚期纤维化 (>F2)，这是实验室参数无法预测的。79% 的患者在 svLbx 后 IS 得到改善。69 名患者在免疫抑制减量后，只有 5 名患者显示 ALT 升高，其中 3 名患者有经活检证实的急性排斥反应，其中 2 名与致命的合并症有关。与开始我们的结构化计划之前的 svLbx 对照组相比，包括排斥反应在内的肝酶升高率没有显着增加。与该对照组相比，免疫抑制减少导致肾功能显着改善。总之，OLT 后活检指导的个性化免疫抑制方案可以识别需要较低免疫抑制的患者或不应进一步减少 IS 的移植物损伤患者。与开始我们的结构化计划之前的 svLbx 对照组相比，包括排斥反应在内的肝酶升高率没有显着增加。与该对照组相比，免疫抑制减少导致肾功能显着改善。总之，OLT 后活检指导的个性化免疫抑制方案可以识别需要较低免疫抑制的患者或不应进一步减少 IS 的移植物损伤患者。与开始我们的结构化计划之前的 svLbx 对照组相比，包括排斥反应在内的肝酶升高率没有显着增加。与该对照组相比，免疫抑制减少导致肾功能显着改善。总之，OLT 后活检指导的个性化免疫抑制方案可以识别需要较低免疫抑制的患者或不应进一步减少 IS 的移植物损伤患者。