A team from Edinburgh, Scotland, investigated the response to a contact neoantigen before liver transplantation as a predictor of acute rejection after transplantation.
41 patients with chronic liver disease were sensitized with 0.1% diphenylcyclopropenone while on the waiting list for orthotopic liver transplantation.
Fourteen days later an elicitation reaction was performed with 5 different concentrations of diphenylcyclopropenone.
The researchers found that 19 patients responded to diphenylcyclopropenone (skin test score range, 1-9) and 22 had no response. Three patients died before transplantation (all non-responders).
|Proportion of patients treated for acute rejection:|
Neoantigen responders: 63%
Non-responders : 5%
12 (63%) of the 19 responders had treatment for acute rejection compared with 1 of 19 non-responders.
In addition, univariate analysis revealed recipient age, donor age, Child-Pugh class, and immunosuppressive agent to be associated with acute rejection.
On multivariate analysis only skin test response was found to be a significant predictor of acute rejection.
All non-responders had no or only mild rejection on biopsy, but 12 of 19 responders had moderate or severe acute rejection on biopsy.
All patients requiring additional therapy to a single course of corticosteroids for acute rejection had skin test scores greater than 1.
Andrew Bathgate, of the Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, said on behalf of his colleagues, "Patients who do not respond to diphenylcyclopropenone sensitization before transplantation develop, at most, mild acute rejection.
"Skin test scores identify patients with troublesome rejection."
"Evaluation of skin test responses to a contact neoantigen may facilitate tailoring of immunosuppressive therapy," he concluded.