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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 - Ann Surg Treat Res (2015)

Bottom Line: The DSA (+) group showed significantly higher levels of class I and II panel reactive antibody (PRA) than did the DSA (-) group.There were no significant differences in graft survival rates between the two groups.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

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.
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Figure 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.

Mentions: Graft survival rates were not significantly different between the DSA (-) and (+) groups. One-year survivals in the DSA (-) and DSA (+) groups were 97.9 and 90.4%, respectively. Three-year survival rates between DSA (-) and DSA (+) were 86.5% and 85.7%, respectively (Fig. 1A). However, in the subgroup analysis, the multiple DSA group showed a lower graft survival rate than the DSA (-) or single DSA group, although this result was not statistically significant. One-year survival rates in the DSA free or single DSA group and multiple DSA group were 91.4% and 85.7%, respectively, and corresponding 3-year survival rates were 85.8% and 75.0%, respectively (Fig. 1B). We divided all recipients into three groups; PRA < 10%, PRA 10%-30%, and PRA ≥ 30%. PRA class II ≥ 30% group showed worse graft survival rate than other groups but there was no significant difference among the group according to PRA class I and II. However, if the PRA percentages of class I and II were summed, PRA ≥ 30% group showed poorer graft survival rates than PRA 10%-30% group (Fig. 2).


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 - Ann Surg Treat Res (2015)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325653&req=5

Figure 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.
Mentions: Graft survival rates were not significantly different between the DSA (-) and (+) groups. One-year survivals in the DSA (-) and DSA (+) groups were 97.9 and 90.4%, respectively. Three-year survival rates between DSA (-) and DSA (+) were 86.5% and 85.7%, respectively (Fig. 1A). However, in the subgroup analysis, the multiple DSA group showed a lower graft survival rate than the DSA (-) or single DSA group, although this result was not statistically significant. One-year survival rates in the DSA free or single DSA group and multiple DSA group were 91.4% and 85.7%, respectively, and corresponding 3-year survival rates were 85.8% and 75.0%, respectively (Fig. 1B). We divided all recipients into three groups; PRA < 10%, PRA 10%-30%, and PRA ≥ 30%. PRA class II ≥ 30% group showed worse graft survival rate than other groups but there was no significant difference among the group according to PRA class I and II. However, if the PRA percentages of class I and II were summed, PRA ≥ 30% group showed poorer graft survival rates than PRA 10%-30% group (Fig. 2).

Bottom Line: The DSA (+) group showed significantly higher levels of class I and II panel reactive antibody (PRA) than did the DSA (-) group.There were no significant differences in graft survival rates between the two groups.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

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.

No MeSH data available.


Related in: MedlinePlus