title: Pre-Transplantation Immune Cell Distribution and Early Post-Transplant Fungal Infection Are the Main Risk Factors of Liver Transplantation Recipients in Lower Model of End-Stage Liver Disease.
abstract: BACKGROUND
  The prognosis of patients after liver transplantation (LTx) with high Model of End-Stage Liver Disease (MELD) score (>30) is predicted, but patients with lower MELD scores (<30) have no conclusive studies of pre- and post-transplant risk factors that influence the long-term outcome.
  
  
  METHODS
  This retrospective study reviewed 268 recipients with MELD score <30, from 2008 to 2013 in our institution, for evaluation of pre-transplant risk factors including patients' clinical background data, pre-transplant lymphocyte subpopulation, and early post-transplant infection complication as predictors for long-term survival after LTx.
  
  
  RESULTS
  The post-transplant patients' survival estimates were 90.7%, 85.1%, and 83.6% at 1, 3, and 5 years, respectively. In multivariate analysis, age >55years, presence of ascites, cluster of differentiation (CD)3 < 93.2 (count/μL), CD4/CD8 <2.4, fungal infection, and more than one site of fungal colonization significantly influenced survival (P = .0003, P = .002, P = .04, P = .004, P < .0001, and P > .0001, respectively). We also noticed that these five factors accumulatively influence the long-term survival rate; this means that in the presence of any two risk factors, the 5-year survival can still be 88.4%, whereas in the presence of any three risk factors, the survival rate dropped to only 57.1%.
  
  
  CONCLUSIONS
  Older patients in the presence of pre-transplant low immune cell number and ascites in association with post-transplant fungal infection are the independent risk factors in MELD scores <30 LTx groups for long-term survival. Patients in these groups with any of the three factors had inferior long-term survival results.
authors.affiliation: General Surgery Department, Al-Azhar Faculty of Medicine, Cairo, Egypt; Liver Transplantation Department, Chang Gung Memorial Hospital, Linko, Taiwan.
authors.forename: N M
authors.initials: NM
authors.lastname: Abdelhamid
authors.affiliation: General Surgery Department, Chang Gung Memorial Hospital, Keelung, Taiwan; Liver Transplantation Department, Chang Gung Memorial Hospital, Linko, Taiwan.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Liver Transplantation Department, Chang Gung Memorial Hospital, Linko, Taiwan.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Wang
authors.affiliation: Liver Transplantation Department, Chang Gung Memorial Hospital, Linko, Taiwan.
authors.forename: C-H
authors.initials: CH
authors.lastname: Cheng
authors.affiliation: Liver Transplantation Department, Chang Gung Memorial Hospital, Linko, Taiwan.
authors.forename: T-J
authors.initials: TJ
authors.lastname: Wu
authors.affiliation: Liver Transplantation Department, Chang Gung Memorial Hospital, Linko, Taiwan.
authors.forename: C-F
authors.initials: CF
authors.lastname: Lee
authors.affiliation: Liver Transplantation Department, Chang Gung Memorial Hospital, Linko, Taiwan.
authors.forename: T-H
authors.initials: TH
authors.lastname: Wu
authors.affiliation: Liver Transplantation Department, Chang Gung Memorial Hospital, Linko, Taiwan.
authors.forename: H-S
authors.initials: HS
authors.lastname: Chou
authors.affiliation: Liver Transplantation Department, Chang Gung Memorial Hospital, Linko, Taiwan.
authors.forename: K-M
authors.initials: KM
authors.lastname: Chan
authors.affiliation: Liver Transplantation Department, Chang Gung Memorial Hospital, Linko, Taiwan; Chang Gung University, Taoyuan, Taiwan.
authors.forename: W-C
authors.initials: WC
authors.lastname: Lee
authors.affiliation: General Surgery Department, Chang Gung Memorial Hospital, Keelung, Taiwan; Liver Transplantation Department, Chang Gung Memorial Hospital, Linko, Taiwan; Chang Gung University, Taoyuan, Taiwan. Electronic address: kodlp62@gmail.com.
authors.forename: R-S
authors.initials: RS
authors.lastname: Soong
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009181:Mycoses / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome