Preformed donor‐specific antibodies do not affect the 1‐year allograft survival in living donor liver transplantation

Abstract

The effect of preformed donor-specific antibodies (DSAs) on liver transplantation (LT) remains unclear, especially in the field of living donor LT (LDLT). Herein, we evaluated the prevalence of preformed DSAs and their effect on graft outcome in LDLT in the first year following surgery. Using the Luminex Single Antigen assay, we analyzed the preoperative sera of 61 adult LDLT recipients between 2014 and 2015. Clinical outcomes and pathologic findings including complement component 4d (C4d) expression in the first year after LT were retrospectively reviewed. Regardless of the class of DSA, DSAs with mean fluorescence intensity (MFI) ≥1000 were defined as positive and preformed DSA with MFI ≥5000 was defined as strongly positive. Fifteen patients (24.6%) had preformed DSAs, and 8 patients (13.1%) showed strongly positive preformed DSAs. Among 15 DSA positive patients, 2 (13.3%) showed persistent DSAs after LDLT. No de novo DSAs were noted in patients without preformed DSAs. Preformed DSAs were not related to graft dysfunction, laboratory values, or C4d expression or other pathologic findings in the first year of LDLT. In conclusion, preformed DSAs persisted during follow-up in 13.3% of cases and did not have adverse effect on histologic or clinical outcomes in the first year of LDLT.

Preformed donor‐specific antibodies are associated with 90‐day mortality in living‐donor liver transplantation

“…Few studies have evaluated anti‐HLA antibodies, including DSAs, using Luminex examination of LDLT recipients in Asia . There has been only one study at Kyoto University (Kyoto, Japan), which reported using pretransplant sera from 18 of 21 recipients whose preoperative CDC tests were positive .…”

“…Kim et al . showed that preformed DSAs were not related to graft or patient survival . In their study, irrespective of the presence of preformed DSAs, the patient survival rate was 100% and the postoperative acute cellular rejection rate was very low.…”

“…Kim et al showed that preformed DSAs were not related to graft or patient survival. 24 In their study, irrespective of the presence of preformed DSAs, the patient survival rate was 100% and the postoperative acute cellular rejection rate was very low. In addition, the patients had very low MELD scores, 70% had hepatitis B virus-related liver cirrhosis, a high proportion had only class I DSAs, and basiliximab was used after transplantation.…”

“…cluding DSAs, using Luminex examination of LDLT recipients in Asia. [22][23][24] There has been only one study at Kyoto University (Kyoto, Japan), which reported using pretransplant sera from 18 of 21 recipients whose preoperative CDC tests were positive. 22 Here, we investigated the expression of anti-HLA antibodies, including DSAs, in LDLT recipients treated at our institution and evaluated their impact on the patients' clinical course over 90 days.…”

Rapid reduction of high-level pre-formed donor-specific antibodies after simultaneous liver-kidney transplantation: a report of two cases

“…In kidney transplantation, the presence of a positive complement-dependent cytotoxic (CDC) crossmatch and a high titre of donor-specific antibodies (DSAs) may be considered a contraindication for transplantation, due to the risk of hyper-acute rejection and subsequent graft loss. In contrast, the presence of preformed DSAs in liver transplant recipients has a much less deleterious clinical effect, with no difference observed in 12-month allograft outcomes in sensitised liver transplant recipients [1]. Simultaneous liver-kidney transplantation (SLKT) may abrogate the risk to the kidney, as illustrated by previous case reports of successful SLKT among highly sensitised patients [2].…”