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Biopsy-proven acute cellular rejection as an efficacy endpoint of randomized trials in liver transplantation: a systematic review and critical appraisal.

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Rodríguez-Perálvarez, Manuel Rico Juri, Juan Manuel [UCL] Tsochatzis, Emmanuel Burra, Patrizia De la Mata, Manuel Lerut, Jan [UCL]

Biopsy-proven acute cellular rejection (ACR) is the primary efficacy endpoint in most randomized trials evaluating immunosuppression in liver transplantation. However, ACR is not a major cause of graft loss, and a certain grade of immune activation may be even beneficial for long-term graft acceptance. Validated criteria to select candidates for liver biopsy are lacking, and routine clinical practice relies on liver tests, which are inaccurate markers of ACR. Indeed, both the agreement among clinicians to select candidates for liver biopsy and the correlation between the clinical suspicion of ACR and histological findings are poor. In randomized trials evaluating immunosuppression protocols, this concern grows exponentially due to the open-label and multicenter nature of most studies. Therefore, biopsy-proven ACR is a suboptimal efficacy endpoint given its limited impact on prognosis and the heterogeneous diagnosis, which may increase the risk of bias. Chronic rejection and/or graft loss would be more appropriate endpoints, but would certainly require larger studies with prolonged surveillances. An objective method to select candidates for liver biopsy is therefore urgently needed, and only severe episodes of histological ACR should be considered as potentially harmful. Emerging surrogate markers of ACR and antibody-mediated rejection require further investigation to determine their clinical role.

Document type Article de périodique (Journal article) – Synthèse de littérature
Access type Accès restreint
Publication date 2016
Language Anglais
Journal information "Transplant International" - Vol. 29, no. 9, p. 961-973 (2016)
Peer reviewed yes
Publisher Wiley-Blackwell Publishing Ltd. ((United Kingdom) Oxford)
issn 0934-0874
e-issn 1432-2277
Publication status Publié
Affiliations UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation
UCL - (SLuc) Service de chirurgie et transplantation abdominale
Keywords acute cellular rejection ; liver biopsy ; liver transplantation ; randomized controlled trial ; transaminases
Links
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Bibliographic reference Rodríguez-Perálvarez, Manuel ; Rico Juri, Juan Manuel ; Tsochatzis, Emmanuel ; Burra, Patrizia ; De la Mata, Manuel ; et. al. Biopsy-proven acute cellular rejection as an efficacy endpoint of randomized trials in liver transplantation: a systematic review and critical appraisal.. In: Transplant International, Vol. 29, no. 9, p. 961-973 (2016)
Permanent URL http://hdl.handle.net/2078.1/176512