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The following is a summary of “Individual mHLA-DR trajectories in the ICU as predictors of early infections following liver transplantation: a prospective observational study,” published in the February 2025 issue of Critical Care by Delignette et al. 

Cirrhosis-related immune dysfunction increases infection risk, a leading cause of early death after liver transplantation (LT).  

Researchers conducted a retrospective study to evaluate immune monitoring, particularly monocytic human leukocyte antigen-DR (mHLA-DR) expression, as a predictor of post-LT complications.  

They analyzed 130 individuals awaiting LT at Lyon University Hospital to evaluate mHLA-DR expression, lymphocyte subsets, and T-cell function before and after LT. Multivariate analysis and K-means longitudinal clustering were used to examine associations between immune trajectories and clinical outcomes.  

The results showed that among 99 individuals who underwent LT, 35.4% developed early post-LT infections. Lymphocyte count and function were not associated with outcomes. Delayed mHLA-DR recovery (Day 7 < 11,000 AB/C) and pre-LT MELD scores > 30 were independent infection risk factors, with ORs of 12.1 [4.4–38.2], P < 0.0001, and 4.9 [1.4–18.4], P = 0.01, respectively. Individuals with delayed mHLA-DR restoration had lower 1-year survival (77.8% vs 98.3%, P = 0.003). K-means clustering identified 3 mHLA-DR recovery patterns, with the slowest recovery group experiencing the poorest outcomes.  

Investigators concluded that mHLA-DR was identified as an early predictor of post-LT nfections, suggesting its potential use in monitoring immune function and guiding individualized management. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-025-05305-x