Donor-Specific Human Leukocyte Antigen Antibody Formation After Distal Tibia Allograft and Subsequent Graft Resorption

Abstract

The association between donor-specific human leukocyte antigen (HLA) antibody formation and small bone allograft resorption has not been studied. We present the case of a patient treated for glenoid bone loss using a distal tibial allograft with Bankart repair who formed donor-specific HLA antibodies against the allograft and had subsequent graft resorption. X-ray and computed tomography (CT) scans were performed before and after surgery at standard checkpoints. Patient blood and serum samples were collected before and after surgery for HLA typing and HLA antibody testing. Human leukocyte antigen antibodies against the donor-specific HLA-A2 antigens were identified 6 weeks after surgery and were still detected at 5 months after surgery. At 6 months after surgery, a CT arthrogram revealed significant graft resorption. This case shows a temporal correlation between HLA antibody formation and clinical findings, potentially suggesting an association between HLA antibody formation and graft resorption. Further study is required to confirm this.

Donor-Specific Human Leukocyte Antigen Antibody Formation After Allograft Glenoid Reconstruction Occurs But Does Not Impact Clinicoradiographic Outcomes

“…Our results elaborate on the findings presented by Liwski et al 5 and O’Sullivan et al 7 regarding postoperative sensitization to donor HLA in the context of small bone allografts. Notably, the case presented by Liwski et al showed evidence of sensitization against donor Class I and Class II HLA.…”

“… 3 , 6 , 7 , 12 , 14 , 16 , 17 However, 2 recent case studies have provided evidence of development of donor-specific HLA antibodies after small bone allografting procedures. 5 , 7 Both cases highlight the potential risks of HLA sensitization after elective surgery, particularly in the case presented by O’Sullivan et al 7 regarding a patient who was placed on a deceased donor waitlist for renal transplant after the sensitization event. Importantly, the case study presented by Liwski et al 5 suggests a possible relationship between postoperative sensitization against donor HLA and resorption.…”

“… 5 , 7 Both cases highlight the potential risks of HLA sensitization after elective surgery, particularly in the case presented by O’Sullivan et al 7 regarding a patient who was placed on a deceased donor waitlist for renal transplant after the sensitization event. Importantly, the case study presented by Liwski et al 5 suggests a possible relationship between postoperative sensitization against donor HLA and resorption. Our study investigated the incidence of HLA antibody formation in a cohort of 71 patients undergoing arthroscopic glenoid reconstruction using distal tibial allografts for the treatment of shoulder instability.…”

“… 1 However, postoperative allograft resorption and nonunion remain predictors of poor outcomes. 1 A recent case study published by Liwski et al 5 has suggested sensitization and antibody formation against donor human leukocyte antigens (HLAs) as a possible mechanism of graft resorption after distal tibial allografting and consequently a potential predictor of recurrent glenohumeral instability.…”

“…Our study investigated the incidence of HLA antibody formation in a cohort of 71 patients undergoing arthroscopic glenoid reconstruction using distal tibial allografts for the treatment of shoulder instability. Also, our study examined the association of HLA antibody formation with the degree of graft resorption and postoperative patient outcomes to expand upon the findings of these 2 case studies 5 , 7 and their possible implications for highly effective allografting procedures. We hypothesized that patients who were sensitized against donor HLA postoperatively would experience higher rates of graft resorption and poor self-reported outcomes compared with nonsensitized patients.…”