Ann Surg Treat Res.  2015 Feb;88(2):100-105. 10.4174/astr.2015.88.2.100.

Effect of donor-specific antibodies and panel reactive antibodies in living donor liver transplant recipients

• Song SH
• Kim MS
• Lee JJ
• Ju MK
• Lee JG
• Lee J
• Choi JS
• Choi GH
• Kim SI
• Joo DJ

• KMID: 1804127
• DOI: http://doi.org/10.4174/astr.2015.88.2.100

Abstract

PURPOSE
Preformed circulating donor-specific antibodies (DSAs) immunologically challenge vascular endothelium and the bile duct. However, the liver is an immune-tolerant organ and can avoid immunological challenges. This study was undertaken to analyze the effects of DSAs after adult living donor liver transplantation (LDLT).
METHODS
We retrospectively reviewed 219 LDLT patients' records treated at our center.
RESULTS
Of the 219 patients, 32 (14.6%) were DSA (+) and 187 (85.4%) were DSA (-). Class I DSAs were present in 18 patients, class II in seven patients, and both in seven patients. Seven patients (3.2%) showed DSA to HLA-A, four (1.8%) to HLA-B, seven (3.2%) to HLA-DR, and 14 (6.4%) to two or more HLAs. More DSAs were observed in female recipients than male recipients in the DSA (+) group. The DSA (+) group showed significantly higher levels of class I and II panel reactive antibody (PRA) than did the DSA (-) group. No significant intergroup differences were found between incidences of primary nonfunction, acute rejection, vascular complication, or biliary complication. There were no significant differences in graft survival rates between the two groups. However, the recipients with multiple DSAs tended to have more acute rejection episodes and events of biliary stricture and lower graft survival rates than did patients in the DSA (-) group.
CONCLUSION
In LDLT, the presence of multiple DSAs and high PRA seemed to be associated with poor graft outcomes, although our results did not reach statistical significance. Large cohort studies are necessary to clarify the impact of DSA and PRA in LDLT.

Keyword

Liver transplantation; Donor specific antibody; Acute rejection; Graft survival; Sensitization

MeSH Terms

Adult
Antibodies*
Bile Ducts
Cohort Studies
Constriction, Pathologic
Endothelium, Vascular
Female
Graft Survival
HLA-A Antigens
HLA-B Antigens
HLA-DR Antigens
Humans
Incidence
Liver Transplantation
Liver*
Living Donors*
Male
Retrospective Studies
Transplantation*
Transplants
Antibodies
HLA-A Antigens
HLA-B Antigens
HLA-DR Antigens

Figure

• 

  Fig. 1 Graft survival rates according to the presence of donor-specific antibodies. (A) No difference in graft survival rates was found between the DSA (-) and (+) groups. (B) However, patients with multiple DSAs had a lower graft survival rate than patients in none or single DSA group. DSA, donor-specific antibody.

• 

  Fig. 2 Graft survival rates according to the percentage of panel reactive antibody (PRA). (A) Graft survival rates of the PRA ≥30% group were lower than the PRA 10%-30% group (P = 0.038) according to the sum of PRA percentage. No significant differences in graft survival rates were found among the PRA percentage groups according to the PRA classes I and II (B and C). However, class II showed more intervals among the groups.

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