Post-liver transplantation GVHD: time to consider histocompatibility testing

Ghandorah, Salim; Alwosaibai, Kholoud

doi:10.1016/j.liver.2021.100021

Cited by 2 publications

(5 citation statements)

References 24 publications

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“…It is especially important when donor's HLA loci are homozygous because blood-related recipients shared one-haploid identical HLA with donors. Although pre-operative evaluation of HLA mismatch and forbidding D → R one-way MM3 is not generally established in guidelines and transplantation centers because of the cost-effectiveness and rarity of GVHD, it is time to consider detailed evaluation to avoid the possibility of fatal GVHD 10 . The reason why two cases (except one who received early re-LT) with D → R one-way mismatch at HLA-A, B and DR did not developed GVHD is unknown.…”

Section: Discussionmentioning

confidence: 99%

The clinical impact of donor against recipient HLA one way mismatch on the occurrence of graft versus host disease in liver transplantation

Kim

Park

Rhu

et al. 2022

Sci Rep

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Graft versus host disease (GVHD) after liver transplantation (LT) is a rare, fatal disease. This study aimed to evaluate the risk factors of GVHD after LT including the human leukocyte antigen (HLA) donor-recipient relationship after LT. LT recipients, who underwent HLA typing together with donors, were included in the study. The donor against recipient (D → R) one-way mismatch of HLA loci was evaluated. HLA relationships, along with basic characteristics, were analyzed as variable factors of GVHD, graft survival, and patient survival. A total of 994 living donor LT (LDLT) and 393 deceased donor LT (DDLT) patients were included. Nine patients had suffered GVHD, four LDLT with D → R one-way at three loci, one LDLT without D → R one-way at three loci, and four DDLT without D → R one-way at three loci. Four (57.1%) of seven LDLT patients, with D → R one-way mismatch at three loci, developed GVHD. D → R one-way mismatch at three loci was related to high GVHD incidence (HR 787, p < 0.001, multivariate). D → R one-way mismatch at three loci was related to graft failure and patient death (HR 9.90, p = 0.020 and HR 12.8, p < 0.001, respectively, multivariate). Only one GVHD without D → R one-way mismatch at three loci, survived despite receiving multiple modalities including tumor necrosis factor-alpha inhibitors. D → R one-way mismatch at three loci was significantly related to GVHD incidence after LT.

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Section: Discussionmentioning

confidence: 99%

The clinical impact of donor against recipient HLA one way mismatch on the occurrence of graft versus host disease in liver transplantation

Kim

Park

Rhu

et al. 2022

Sci Rep

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“…This systematic review clearly demonstrates that there is a general agreement (17 out of 21 cases) upon the importance of HLA typing and chimerism analysis in confirming or predicting the incidence of GVHD post‐LT. In our previously published report, we proved that the addition of FCXM and anti‐HLA antibodies to HLA typing and chimerism analysis methods could predict the risk of GVHD post‐LT and support identifying a suitable donor 22 …”

Section: Discussionmentioning

confidence: 71%

“…In our previously published report, we proved that the addition of FCXM and anti-HLA antibodies to HLA typing and chimerism analysis methods could predict the risk of GVHD post-LT and support identifying a suitable donor. 22 It is important to note that the reported cases showed a substantial delay in confirming the diagnosis of GVHD post-LT. This delay can significantly impact the severity of GVHD incidence and the treatment intervention plan.…”

Section: Discussionmentioning

confidence: 88%

“…Biopsy samples were taken from skin (10 cases), bone marrow (1), intestinal (2), colon (1), or both skin and gastrointestinal biopsies (1). The other cases diagnosed GVHD post‐LT based on the clinical symptoms, 11 chimerism analysis, 3 or chimerism analysis together with the skin biopsy 5,22 …”

Section: Resultsmentioning

confidence: 99%

“…The other cases diagnosed GVHD post-LT based on the clinical symptoms, 11 chimerism analysis, 3 or chimerism analysis together with the skin biopsy. 5,22 The HLA typing, chimerism analysis or both were performed in 18 out of the 21 cases. HLA typing was performed using serological and molecular techniques.…”

Section: Hla Typing and Chimerism Analysis In Diagnosis Of Gvhd Post-ltmentioning

confidence: 99%

See 2 more Smart Citations

Role of HLA typing and chimerism analysis in post‐liver transplantation GVHD in pediatrics: A systematic review

Ghandorah

Alsawaf²,

Alrefai

et al. 2022

Pediatric Transplantation

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Background GVHD is a well‐documented complication after liver transplantation. GVHD occurs when donor immune cells mount a destructive immune response against host cells. The rarity of the GVHD complication and the nonspecific presentation of symptoms and histopathological features provide a diagnostic challenge. Therefore, diagnosis and initiation of treatment are often delayed. Aim In this systematic review, we assessed relevant literature to better understand the utilization of HLA typing and chimerism analysis in liver transplantation. We mainly focused on their importance in diagnosing GVHD incidence after liver transplantation. Results A total of 18 articles reported 21 cases of GVHD after liver transplantation in pediatrics. Generally, there is a consensus on the advantage of HLA typing and chimerism analysis in confirming the diagnosis of GVHD after liver transplantation. However, there is an inconsistency in the timing and the application of the accurate HLA typing and chimerism analysis. Conclusion Further studies are required to assess the incidence of GVHD post‐LT and to determine the impact of HLA typing and chimerism analysis in assessing the risk, early determination of GVHD incidence, and improving outcomes. This systematic review highlights the gap in the field of liver transplantation and calls for revisiting the guidelines to consider HLA typing and chimerism analysis in predicting GVHD before transplantation and diagnosing GVHD incidence after liver transplantation.

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Post-liver transplantation GVHD: time to consider histocompatibility testing

Cited by 2 publications

References 24 publications

The clinical impact of donor against recipient HLA one way mismatch on the occurrence of graft versus host disease in liver transplantation

The clinical impact of donor against recipient HLA one way mismatch on the occurrence of graft versus host disease in liver transplantation

Role of HLA typing and chimerism analysis in post‐liver transplantation GVHD in pediatrics: A systematic review

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